GPs are facing heightened scrutiny over use of diagnostic scans, as PCTs scrap direct access to save costs, a GP investigation has found.
Responses from 116 PCTs to a Freedom of Information request revealed that 28% of PCTs are benchmarking practices' referrals to diagnostic scans or plan to do so. In addition, a quarter of PCTs are supporting practices to reduce inappropriate access to scans.
Others are taking more drastic action. Nine trusts have identified practices whose use of diagnostics is deemed excessive or under-used.
The government prioritised GP access to diagnostic scans in its cancer strategy last year and PCTs were instructed to improve direct access as part of the 2011/12 NHS Operating Framework.
But five PCTs have decommissioned some direct access schemes to key diagnostic scans, such as MRI, CT and ultrasound.
One trust has implemented strict upper and lower target levels of use, and another is considering introducing limits.
GPC negotiator Dr Chaand Nagpaul said giving GPs greater access to scans reduced the need for specialist referral.
'It is simplistic and misguided just to focus on costs,' he said.
'An intelligent approach would be to have guidelines for appropriate use of diagnostics and incorporate them into the pathway.'
RCGP chairwoman Dr Clare Gerada said restrictions and targets on accessing diagnostics 'deprofessionalises' GPs.
'How can a junior doctor in a hospital refer for an ultrasound, but I - with 25 years' experience - have to refer a patient to a specialist?
'This is about money and finances driving behaviour by the PCT - not about putting patients first.'
She said restricting GP access will delay diagnosis of cancer. 'We cannot move towards PCTs acting as though they are in the consultation room.'
Cancer Research UK's director of policy Sarah Woolnough said it was 'perfectly reasonable' for PCTs to review referral patterns and spot outliers. This could help identify low referrers who would benefit from support.
But she added: 'It is very worrying to hear of PCTs setting referral targets and decommissioning direct access to tests that could speed up a cancer diagnosis.'
In one case, NHS South West Essex saved £100,000 by decommissioning routine direct access to MRI and CT scans as part of the Quality, Innovation, Productivity and Prevention (QIPP) programme in 2010/11.
The trust expects to save up to £250,000 in 2011/12 by continuing the policy.
Professor Sir Mike Richards, England's national clinical director for cancer, said: 'Early diagnosis of cancer is a very high priority for the government. That is why the Cancer Outcomes Strategy, which we published earlier this year, put an emphasis on improved GP access to diagnostic tests.
'We are working to improve access to relevant diagnostic tests for GPs and will shortly be publishing guidelines which have been developed by GPs working with radiologists and other specialists. We are planning to collect information on the use of imaging across the whole country.'