GPonline’s poll revealing that nearly one in three GPs have had a referral on the two-week cancer pathway blocked over the past year is a concerning revelation for practitioners and patients alike. But what should doctors be considering from a legal perspective when their hands are tied?
It is a real worry that any tactic could be used by a hospital to block or even delay access to diagnostic tests for any reason, particularly where the referral is urgent. The patient’s needs should be at the centre of healthcare provision.
Should hospitals simply be overwhelmed, then we should be looking at how to address this problem with them, rather than having hospital trusts attempt to solve this themselves. Downgrading referrals is not a solution, as this delays the diagnosis of patients with symptoms found to have cancer. An initial consultation in a nurse led clinic is not an alternative, or what is required under NICE guidance.
Should a GP face difficulties when referring a patient for diagnostic tests, despite the lower threshold, they should persist in chasing for the appointment/scan. They should consider all alternatives to ensure that the patient has their test/appointment within the timescale required. Symptoms found by a GP should be taken seriously by hospital trusts, and their clinical view respected so that the recommended tests take place.
So long as a GP is doing everything in their power to ensure that the patient has their diagnostic test when required, they should not be concerned about legal liability for medical negligence. Should a trust continue to resist making arrangements for tests, I would suggest that a record is kept of these difficulties and that this is raised formally through a written complaint.
Direct access to MRI and CT scanners are a useful step forward to make the journey to diagnosis and treatment faster for patients. We are some way behind the timescale envisaged for the recommendations that direct access to these tests be made more widely available to GPs.
It is difficult to understand why this may be the case, apart from short term cost saving. Where a patient is treated earlier, it is very likely to cost the NHS less in the long term. I would say that in such an urgent situation where a patient has already been found to have symptoms, budgetary considerations should in any event take second place to patient care.
- Suzanne Trask is a partner and head of the clinical negligence department at Bolt Burdon Kemp