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Hospital consultants warned after bouncing suspected cancer cases back to GPs



Exclusive An NHS England local area team has had to contact hospital clinicians about their referral practice after GPs raised the alarm that patients with suspected cancer were being ‘bounced’ back for re-referral.

Local leaders across the country have told Pulse that they brought the issue up with their local area teams after concerns that patient safety was being put at risk.

In the south coast of England, NHS England’s Wessex Cancer Network sent a letter to hospitals saying the behaviour was ‘inappropriate’ and ‘against patients’ best interests’ after receiving reports that hospitals across the region had been ‘sporadically’ asking GPs to refer patients with suspected cancer via the two-week wait referral pathway.

Local GP leaders said that they suspected ‘heavy handed’ attempts to drive down consultant-to-consultant referrals in the past were responsible for the behaviour, which was causing ‘unnecessary delays’ for patients.

Pulse revealed in December that urgent GP cancer referrals sent via the two-week wait pathway were being ‘bounced’ or downgraded to non-urgent, in some cases leading to delays in cancer diagnoses.

But the action by the NHS England Wessex area team is the first example of managers rebuking hospitals for bouncing suspected cancer cases back to GPs.

A spokesperson for NHS England Wessex area team said: ‘Secondary care clinicians who suspect that a patient may have an underlying cancer, should refer the patient directly to the appropriate local cancer specialist.

‘This prevents unnecessary delay in diagnosis and treatment, and is in line with cancer waiting time guidance. The local strategic clinical network has reminded clinicians of this process, maintaining the best interests of the patient and further clarifying that in such cases, a referral back to the patient’s GP is both inappropriate and unnecessary.’

Dr Nigel Watson, chief executive of Wessex LMC, that such a pattern was being observed across the south coast of England.

He said: ‘It’s happening sporadically, but in more than one hospital. So GPs have got quite frustrated… I think what’s happened is that, in the past, to try and stop inter-consultant referrals, there was quite a heavy hand to stop this happening, and then some consultants believe that they weren’t allowed to refer.’

Dr Watson added: ‘It is a complete waste of time, because somebody is seeing the patient, thinking they might have cancer, then bouncing them back to the practice to write the letter. So it’s a delay for the patient, and it’s just unnecessary and the person seeing the patient has got all the details they need.’

GPC negotiator Dr Beth McCarron-Nash said it was happening in Cornwall too and it was ‘unacceptable’.

She added: ‘The patient appears to have been missed in this picture. The heavy handed approach and drive to balance books appears to be more important than good clinical care. This is madness and should be challenged as it compromises safe patient care.  We raised our concerns and things are improving. The needs of the patient and common sense must come first.’

Dr John Ashcroft, executive officer at Derby and Derbyshire LMC, said he would be proposing a motion to tackle it at the next LMCs conference.

Dr Ashcroft said: ‘It’s much broader than just those with suspected cancer, there are many other serious conditions, and less serious conditions where the patient journey is affected by this policy.

‘It adds delays, and confusion to the patient’s journey, wastes appointments and causes huge amount of extra admin work for doctors and staff. It’s also demeaning to our hospital colleagues.’

Pulse revealed in 2013 that CCGs across the country had been piling pressure on to GPs by blocking non-urgent ‘inter-consultant’ referrals on a range of conditions in a bid to cut their spending and achieve their QIPP savings targets.