Cancer referrals are 'downgraded'

Welsh consultants veto 'urgent' cases.

The lives of patients in Wales are being put at risk, because consultants can downgrade cancer referrals without discussion with GPs.

Following an urgent suspected cancer referral, a patient is supposed to see a specialist within two weeks.

But Dr Ian Millington, a Swansea GP, said a patient was not seen for nine weeks, because the consultant thought her case was not urgent.

When eventually examined, she was diagnosed with an inoperable throat tumour.

Dr Millington said that, although the patients' symptoms were relatively minor, 'knowing her as I did, I knew her reports of minor symptoms were enough to create anxiety'.

He was disturbed that a consultant had de-prioritised a patient in this way without first talking to the referring GP.

'It wouldn't have saved this patient's life,' he said. 'But it might save others.' Poor communication by consultants was an 'ongoing problem'.

The legislation which implements the two-week target was phrased differently in different parts of the UK. Consultants in Wales can reclassify the urgency of a case, while consultants in England cannot.

A spokesman for the Welsh Assembly government said: 'The specialist can downgrade urgent referrals, but they can upgrade referrals too. Where referrals are downgraded the GP must be informed.'

Dr Millington also said he was disturbed by consultants' reactions after he complained he was not informed when his patient was downgraded.

The position in Scotland appears to mirror that in Wales. A Scottish Executive spokesman said: 'Classifications of cancer referrals are clinical decisions for those involved in the case.

'In a case where there may be cause to downgrade the urgency of a referral, we would expect systems to be in place at a local level to ensure that the referring doctor is informed.'

A spokesman for the Department of Health, Social Services and Public Safety in Northern Ireland was unable to comment.

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