The report by The Health Foundation, in collaboration with former national cancer director Professor Sir Mike Richards, said that previous efforts to encourage GPs to refer early have been met with ‘resistance from commissioners under pressure to limit referrals, and by limited hospital capacity to meet demand for diagnostic tests’.
Earlier this year GPonline found that nearly half of GPs have had a referral on the two-week cancer pathway bounced back or downgraded to non-urgent within the previous 12 months - often for patients later found to have cancer.
The Health Foundation's report said that while progress has been made on improving survival and experiences of care for people diagnosed with cancer, England still had poorer survival rates that other European countries. It said early diagnosis was the key to improving outcomes.
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The report recommended that NICE guidelines, which say that GPs should investigate patients who have symptoms indicating a 3% or higher risk of cancer, should be fully implemented.
It said that 'some, but not all, CCGs have changed their referral templates to comply with the guidelines and tools are being developed to assist GPs in assessing levels of risk’. But, the report added, much more work will be needed to change GP practice and raise public awareness about symptoms of possible cancer.
The report concluded that ‘more patients will undoubtedly need to be investigated’ if England was to improve cancer survival rates.
Cancer scans
The Health Foundation said that while there has been recent investment in equipment to treat cancer, the UK had 'fallen far behind other countries in the availability of diagnostic equipment per person, ranking 35th out of 37 countries for CT scanners, and 31st out of 36 for MRI scanners.’
The number of CT and MRI scans undertaken in the UK had increased, but the UK still laggged far behind other countries in terms of the number of scans being done, the report added. It said this was unsurprising 'given the relative paucity of equipment'.
A shortage of staff to operate the machinery and report scan results was also contributing to delays in diagnosis and treatment.
GPC chair Dr Richard Vautrey said that early diagnosis and intervention relied on ‘a streamlined system that supports GPs in making timely referrals’.
‘While we appreciate the pressures that many commissioners find themselves under, they should be encouraging this process, rather than frustrating it, so that all patients who need a referral for further investigation get one,’ he added.
‘GPs need rapid access to diagnostic services, such as MRI or CT scans, and, where appropriate, certain patients should be able to directly access tests themselves where clinical evidence supports this.
‘All GPs should have the option to refer patients with relevant symptoms directly for investigations to be then followed up by a consultation with a specialist. One-stop clinics can also be helpful, so that patients get the tests and results on the same day.’
