Having direct access to ‘fast-track’ cancer tests will make matters worse for both GPs and patients, argues Dr Tony Copperfield
I realise there’s no pleasing some, especially me. But am I alone in feeling a bit queasy about the latest plans enabling all GPs to order MRIs, CTs et al? There has been a reflex sense of jubilation among some that makes me wonder whether we’re aligned, planet-wise.
I didn’t even have to think about this – the following 10 drawbacks to this initiative just popped unbidden into my head.
1. It will stoke patient demand.
2. I will no longer be able to defuse or deflect that demand by explaining that a scan will in fact require a specialist referral.
3. I am not trained in knowing exactly what type of scan is appropriate for what type of problem.
4. Even if 3 was resolved, I remain not trained in knowing how to interpret the results of these scans.
5. It will increase indiscriminate scanning, partly because of the above but also because the frontline is increasingly run by test-trigger-happy noctors, though I accept that GPs are perfectly capable of investigative brain-farts, too.
6. Increased scanning will increase the incidence of incidentalomas, fuelling patient anxiety.
7. There will be no doubt who is responsible for the interpretation and management of these incidentalomas – there’s no point me bouncing them back to myself.
8. I will retain all clinical responsibility for cases which would otherwise have been diluted out by referral.
9. If the scan is negative, not knowing what to do will be my problem rather than the specialist’s, and if I end up referring anyway then I have simply delayed the patient’s entry into secondary care.
10. 1,2,5,6 and 7 of the above will simply increase scan waiting times, defeating the object. And this will then be my fault, according to the patient, as I am the scan gateway/pathfinder.
So, personally, I see this marvellous new fast-track access as making matters worse for GPs and patients. It smells like another rushed, ill thought-out, bolt-on, populist scheme, the funding for which could and should have been used to make the current, more rational system work properly.
Then again, you could say I’m so negative I need my head scanning. If so, I know who to speak to.
Dr Copperfield is a GP in Essex. Read more of his blogs here