The exclusive survey finding headlining this fortnight's GP (page six) is that CCG-imposed restrictions are preventing up to half of GPs from directly referring their patients for cancer diagnostic tests.
This is less of a problem in areas where the two-week wait target is adhered to and is perhaps understandable for MRI and CT scans, but far less so for cheaper X-rays and ultrasound scans.
Allowing GPs to refer for these plays to their gatekeeper strength and means secondary care clinics are dealing with far fewer potentially inappropriate cases.
The GP who refers directly for a scan could expect to resolve the case within days, or pass on only the most appropriate cases, meaning clinics are only seeing the patients most likely to need their help and overall waiting times are reduced.
CCGs investing in this way should expect to be reducing cancer waiting times, improving patients' experience and making the most of GPs' role as gatekeepers. Yet our survey found that GPs in 22% of CCG areas are barred from direct access to any tests at all.
This comes despite a £450m investment to improve outcomes in cancer care, detailed in the government's 2011 strategy for cancer, and the pledge that GPs need to be able to access the tests directly and that it is the role of CCGs to commission them.
CCGs point out that they use the two-week urgent referral pathway, but doing so leads to longer waiting times and greater overall costs.
A third of CCGs commission all tests and it will be those CCGs which are investing in this way at a crucial point in the patient's clinical journey that will ultimately benefit all.