Exclusive: GPs and patients face postcode lottery accessing diagnostics

Discrepancies in PCTs' commissioning mean GPs in neighbouring areas of England have vastly differing direct access to diagnostics, an investigation by GP newspaper has found.

Investigation found that GPs can have vastly differing direct access to diagnostics
Investigation found that GPs can have vastly differing direct access to diagnostics

GP commissioners will need to increase funding for direct access diagnostic services costing hundreds of thousands of pounds to meet the government’s cancer drive as GP newspaper found huge variations in the existing extent of PCTs' commissioning.

Responses from 85 PCTs to a Freedom of Information request shows the vast majority commission at least one type of direct access scan.

But this number varies from comprehensive access to 16 scans to just one scan, accessible by only two practices.

Government’s cancer strategy
Over the next four years commissioners will need to ensure GPs have much improved direct access to the full range of diagnostics as part of the government’s £750m cancer strategy.

A portion of the £450m set aside to improve earlier diagnosis of cancer will fund increased GP access. This aims to improve England's cancer survival rates, currently among the lowest in Europe.

The NHS Operating Framework 2011/12 sets out how PCTs must begin to take action to provide this.

RCGP imaging lead and Yorkshire GP Dr Nick Summerton said GPs wanted increased direct access to scans to avoid patients with non-urgent symptoms waiting months to see a hospital consultant.

Variations in access
While some PCTs pay for a full range of direct access scans, others close by do not commission any.

NHS Cambridgeshire commissions direct access non-obstetric ultrasound, dual-emission X-ray absorptiometry (DEXA) and flexible sigmoidoscopy for practices in its region.

But its neighbouring PCT, NHS Norfolk, said it does not commission any direct access scans.

NHS Central and Eastern Cheshire pays for GP direct access to 16 tests and scans including MRI, nuclear medicine, X-ray and cytology.

NHS Lincolnshire said just two practices in the PCT’s area have access to ultrasound equipment.

Some PCTs have opted to decommission some access to scans to make savings as part of the Quality, Innovation, Productivity and Prevention (QIPP) programme.

NHS South West Essex decommissioned routine MRI and CT scan access for GPs, saving an estimated £350,000 over two years.

NHS Stockport saved £513,000 a year by cancelling a contract for direct access MRI.

More funding needed
The sums suggest GP commissioners will need to find hundreds of thousands of pounds from within squeezed budgets to re-instate direct access as required by the government, although this task will be helped by the cancer strategy fund.

GPC negotiator Dr Chaand Nagpaul said: ‘Prompter diagnosis has been achieved by giving GPs direct access. That is what we should be doing: promoting access.’

Sarah Woolnough, Cancer Research UK’s director of policy, said: ‘Early diagnosis is critical to improving cancer outcomes, so we would want to understand how PCTs are prioritising efforts in this area. If the decommissioning of direct access to tests was being made on cost grounds, we would want PCTs to reconsider.’

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