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UK GPs are ‘bending the rules’ on cancer guidelines to benefit patients



Some 90% of UK GPs say they would ignore clinical guidance and send their patients for tests if they suspected cancer but the symptoms did not fit the criteria for urgent referral. 

A new study on the international variation on adherence to cancer-specific referral diagnostic guidelines, led by researchers in the University of Oxford, found that 20% of these GPs said they would ‘record the patient’s history in such a way that allowed them to fit the guidelines for urgent referral’.

GPs in England, Northern Ireland and Wales are less likely to follow recommendations than their non-UK counterparts, the study, published in the British Journal of General Practice also found.

Significantly, the study found no link between adherence to guideline recommendations for definitive action and one-year cancer survival rates.

The research aimed to explain the variation in cancer survival between nations with comparable health systems by exploring the international differences between clinical guidelines and their thresholds for referral, the definitive action they recommend, and guideline adherence by clinicians.

Study lead author Dr Brian Nicholson, a GP and clinical fellow in Oxford University’s Nuffield Department of Primary Care Health Sciences, said: ‘‘What’s interesting here is the tendency for GPs to ”bend the rule”’ to ensure patients presenting with concerning symptoms, who do not fit rigid referral criteria, get rapid assessment anyway. This suggests some GPs shared the view of patients, who would prefer to be investigated for suspected cancer at a much lower risk threshold than was recommended at the time of the study.’

Dr Nicholson added: ‘The new 2015 NICE guideline reduces the suspected cancer referral threshold for GPs to allow for more referrals. Since our data suggests that GPs would sometimes already operate outside the guidelines, perhaps the lower threshold used in the new guideline more closely represents current GP best practice.’