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Hospitals told to slash waits as GP cancer referral rates spike

Hospitals told to slash waits as GP cancer referral rates spike

Hospitals have been ordered to reduce the number of patients waiting too long for cancer investigation amid GP referral rates that are currently one fifth higher than before the pandemic.

In a letter to trusts and ICBs, sent at the end of last month, NHS England said cancer referrals ‘now constitute one in every four’ GP referrals to an acute trust.

It went on to task hospitals with cutting the number of patients waiting more than 62 days from urgent referral for suspected cancer to treatment to pre-pandemic levels. But it said this will mean reducing the cancer waiting list by 14,000 patients by March next year.

The data stands in contrast to claims earlier this year that GPs were ‘fobbing off’ patients with cancer symptoms.

The letter said: ‘We need to reduce long-waiters at a time when referral levels for suspected cancer are as high as 120% of pre-pandemic levels and now constitute one in every four GP acute referrals’.

According to NHS England, 85% of those waiting more than 62 days to start treatment are being delayed by diagnostics and the focus should be on lower gastrointestinal, urology and skin pathways – which account for two-thirds of the backlog.

The next phase of the elective recovery plan will also focus on patients waiting longer than 78 weeks for care.

The letter said: ‘We know that solving this challenge, given the high volume of new patients, will involve carving out recurrent additional diagnostic and treatment capacity.

‘Whilst progress in reducing the backlog has understandably been challenging in the context of wider pressures, this now needs to be seen as a critical priority for the remainder of the year.

In a statement published this week, NHS England added: ‘Thanks to NHS campaigns and early diagnosis initiatives, suspected cancer referrals have remained at record levels over the last 16 months, reaching 121% of pre-pandemic levels in the month of May 2022.’

NHS England also announced this week that bowel cancer referrals have hit a ‘record’ high, with more than 170,500 people referred for checks for suspected lower gastro-intestinal cancers between May and July.

This is up by more than 30,000 compared to the same period last year and nearly 80,000 higher than two years ago, it said.

‘Referrals for bowel cancer hit an all-time high in the second week of July, up 60% on pre-pandemic levels’, it added.

But official data for June shows that only 60% of patients referred by their GP for suspected cancer are starting treatment within two months.

This is a ‘new worst on record’ for the target, which aims to have 85% of people starting treatment for cancer within 62 days of an urgent referral from their GP, Macmillan Cancer Support said.

According to an analysis by Macmillan, the total number of those who have started cancer treatment in England since the start of the pandemic is still more than 30,000 lower than expected.

It said this figure ‘has barely changed for months, suggesting little progress is being made in catching up with missing treatments’.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, told Pulse that the NHS England statistics ‘show the importance of looking at the whole care pathway’.

He said: ‘A lot of the focus in the past has been on GP referrals. But GPs now find themselves referring patients but with the NHS not meeting targets for starting treatment for many patients.

‘Some of the delays are due to delays in getting diagnostic tests and this needs to be addressed in addition to the other part of the care pathway such as GP referrals, outpatient appointments, and treatment (e.g. chemotherapy, radiotherapy, surgery).’

RCGP vice chair Dr Gary Howsam said: ‘There was a drop in cancer referrals by GPs at the start of the pandemic, which research shows was mainly due to people following official guidance to stay at home, but referral rates are now consistently exceeding pre-pandemic levels.’

He added: ‘Against a backdrop of increasing workload and falling GP numbers, overall referrals by GPs through rapid suspected cancer pathways are 20% higher than pre-pandemic levels. 

‘What’s more, more than 75% of patients who are found to have cancer are being referred after just one or two consultations, showing that GPs are doing a good job at identifying suspected cancers and referring appropriately.’

Dr Howsam added that the Government must act ‘urgently’ to provide GP practice teams with ‘the necessary resources to improve the early detection of cancer, including a sufficient workforce and better access to diagnostic testing in the community’.

The RCGP has also warned that tackling the backlog of care is ‘vital’ to alleviate pressures in general practice, which has been left to ‘pick up the pieces’ while patients remain on the waiting list or need to be re-referred, at a time it is ‘already stretched beyond endurance’.

It comes as figures show the number of people waiting for more than two years for elective care – the focus in the first phase of the elective recovery plan – fell from 22,500 at the start of the year to fewer than 200.

But the latest figures show the overall waiting list has grown again to 6.8 million people.

In setting out its elective recovery plan, NHS England said the increase in elective activity would predominantly be achieved through increased GP advice and guidance (A&G). 

The plans were first revealed in draft guidance seen by Pulse in March, which set out that GP A&G ‘could contribute an estimated six percentage points’ towards the target of ‘over 10% more’ activity.

Meanwhile, NHS England has warned that plans to invest in cancer services and community diagnostics, as well as in primary care, could be impacted by the NHS having to find funding for staff pay rises.


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Please note, only GPs are permitted to add comments to articles

David Banner 16 August, 2022 11:01 am

So how will hospitals slash waiting times given higher GP 2WW referral rates and dwindling resources??
Any GP referring in recent months already knows the answer.
– bounce back the referral with pressure to downgrade from 2WW (guess who keeps medicolegal responsibility). CAMHS perfected the art years ago. After a while you give up even trying……..
– start insisting on time consuming investigations before accepting referral (No FIT test? No appointment!)
-shame GPs by changing the media narrative from “incompetent GPs failing to refer early enough” to “incompetent GPs flooding 2WW system with inappropriate referrals”
– produce league tables to name & shame the over-referrers with lowest cancer pick up rates. (Actually our local friendly PCNs will be press ganged into producing these audits soon any way).
Job done!

Michael Mullineux 16 August, 2022 12:58 pm

Spot on DB.
Our local trust reject referrals that are incomplete for minor details that are not included like current BMI, so desperate are they to buy a few extra weeks to meet targets

Niall Lynch 16 August, 2022 3:23 pm

I’m a Hospital Doctor(Radiologist) and we are trying to cope with more work with the same stuff. We have the same number of staff and the same number of machines but are expected to do more work. Few are willing to do extra lists as the pension crises affects the older Doctor while the younger ones have childcare commitments.
There is a big increase in referrals for cancer but the pick up rate is low. NICE recommends a pick up rate of 3% for CT colon studies- ours is less than 1%. Prostate imaging is clogging up our MR scanner. Neck scans for nodes clogs up our US lists. Our ED department requests have exploded since COVID.
Extra work that we are expected to magically do in the free time we have between the stuff we do already. Does that sound familiar?

Darren Tymens 16 August, 2022 7:28 pm

Cancer referral rates are up 20% because GP attendance rates are up 20%.
Current NICE-backed clinical guidelines do not allow us any discretion or leeway in interpretation: if the patient meets the criteria the GP has to refer or risk enormous criticism and/or legal action.
Hospitals have been given, what, around 36 billion to cope with the extra work? What exactly have they spent it on?

Sam Tapsell 16 August, 2022 9:09 pm

Referral management encourages us to dress up any referral as ?cancer, otherwise it will be sent back for some spurious reason.
GP traige of patient requests encourages patients to insist on urgent review when perhaps they know not urgent.
And pensions mayhem encourages any well paid clinician to decline extra work incase they earn an extra 10,000 but lose 20000.
This means the system is miserable for patient and clinicians, and has huge churn of wasted resources on triage which would be better spent seeing patients.
The best GP triage system I ever saw was a turn up and wait room: turn up early and know you will be seen, turn up late and see a full room, suggest come back another day. Turning blue? Unwell child? Rest of waiting room would ask you to see them first…it really worked.

Patrufini Duffy 17 August, 2022 12:35 pm

Yes Sam. Good old days were like that. The urgent same day panic attack and bloating 24 year old, can turn up and sit next to the elderly for a life chat. What you here for? Oh, I was bored and WFH – my friend Emily said I should get all my moles checked. Why are you here? Oh, I’ve got cancer and broke my hip last week and haven’t eaten smashed avocados for 2 weeks.

David jenkins 17 August, 2022 12:54 pm

Sam Tapsell

remember tony blair’s brilliant idea ? if you can’t get an appointment with your GP “in a timely manner”, they were going to fine the GP £2000.

i was a single handed, rural, dispensing GP in wales. one day i opened my payslip, to discover they had “witheld” £2000 from my pay.

when i rang and queried it, i was told it was because “it’s impossible to get an appointment to see you within two weeks”

i pointed out it was indeed impossible………..because i didn’t have an appointment system ! you can come anytime the door is open.

they insisted they should have an appointment, and wouldn’t budge……………until i threatened them with the local rag, and the daily wail. “who should i tell them to ask for when they phone this number ?” i asked…………”i’m sure they will want to interview you” !!

pregnant pause, and audible gulp on the phone. “er……….we didn’t realise how your surgery worked”

and they gave me my own £2000 back !

just shows the calibre of those running the system !!

David Church 17 August, 2022 9:27 pm

@Niall Lynch : could you not improve your rates of colon CT pickup to meet the national target, by sending an extra 2% to surgery? That should please everyone, shouldn’t it? Slightly less accurate reporting, maybe, a little less solid in it’s reassuarance of lesion-absence, and everyone is happy – especially the private GI surgeons, because people will be desperate enough to pay to avoid waiting in the current situation.

This government’s whole idea is a little like shouting at the bath drain for not letting the water out fast enough when you have both clogged the plug-hole with a year’s-worth of hair trimmings, AND had an extra 6 taps installed, AND had a grand sponsored bath-filling event with bucket-chain-gangs competing to fill it faster, and removed the roof to let the rain into it.