One in three (32%) referrals made by GPs through the two-week wait cancer pathway were downgraded as less urgent over the last year, according to responses from 264 salaried and partner GPs to a GPonline poll. A total of 27% had had a referral bounced back or refused over the last 12 months.
Overall, 39% had a referral either downgraded or bounced back, and 23% of GPs whose referrals been handled in this way later discovered that the patient affected did have cancer.
GP leaders warned that restricting GP access to diagnostics was ‘short-sighted’ and could have ‘devastating’ consequences for patients.
Cancer diagnostic tests
The survey also revealed that many GPs are being denied direct access to some vital cancer diagnostic tests, despite directives – such as those set out by the Independent Cancer Taskforce established as part of the NHS Five Year Forward View – that practices should have access to these scans.
NICE has also called for GPs to have direct access to diagnostics, setting out evidence that the move would make the NHS more cost-effective and reduce the time taken for diagnosis.
The vast majority of responding GPs reported that they had access to blood test, chest X-ray and ultrasound diagnostic tests, the poll found.
But access to MRI, CT and endoscopy tests is considerably more patchy, the results suggest. Only half (52%) said they had direct access to CT scans, 58% to MRI tests and 62% to endoscopy.
Respondents said they were only allowed to refer for MRI in ‘certain circumstances’, such as for specific body parts.
One said they had to ‘phone a radiologist for permission first’ before being able to refer patients for MRI or CT tests.
GPC clinical and prescribing lead Dr Andrew Green said: ‘The two-week wait pathway should be available for all cases where a GP suspects cancer, and as patients are sometimes inconsiderate enough not to present with text-book symptoms, this service should not be restricted to a limited list of clinical features.
‘Useful work by local cancer leads often demonstrates to practices that they have low two-week wait referral numbers, combined with high conversion rates, showing that they should use the fast-track system more often.
‘Good access to diagnostics has been GPC policy for many years, and is supported by groups such as Cancer Research UK. Unfortunately, many CCGs are reducing what access is available on the grounds of cost-cutting, which is short sighted to say the least, as little is more expensive – or personally devastating – than a late cancer diagnosis.
‘Poor diagnostic access will also increase outpatient referral rates, where the investigations are almost inevitably performed anyway.’
An NHS England spokeswoman said: ‘We know that catching cancer early helps improve outcomes, while recognising that expert cancer specialists may following GP referral then be able to reassure a patient that their situation is not in fact medically urgent.
‘The NHS is investing in new ways of enabling speedy access to multi-disciplinary diagnostics through the £200m available to Cancer Alliances for cancer transformation over the next two years.’