GPC hits out at 'simplistic' ranking of GP cancer referrals

GP leaders and health officials have defended GPs' performance on cancer referrals, after reports suggested many are failing to refer patients with symptoms quickly enough.

Dr Nagpaul: 'many cases of cancer by their nature can be deceiving by not presenting with clear signs or symptoms.'
Dr Nagpaul: 'many cases of cancer by their nature can be deceiving by not presenting with clear signs or symptoms.'

GPC chairman Dr Chaand Nagpaul said recently published data that ranked GP two-week-wait referrals for cancer must not be used ‘to unreasonably penalise GPs’.

A senior health official said the data was not a clear measure of practices' performance at spotting cancer.

Their comments came after NHS England publicly published 40 new health datasets through the NHS Choices website on Friday. These included data from 4,000 practices on the percentage of cancer cases that were referred through the two-week-wait pathway.

National media reports over the weekend said the data showed that in around half of practices, fewer than 50% of patients had been referred via the two-week-wait pathway. Some articles suggested this was because GPs may be 'failing' patients.

Commenting on the data, Mark Flannagan, chief executive of Beating Bowel Cancer, said: ‘It is intolerable that patients who are presenting to their GP are not being referred fast enough to ensure any cancer is swiftly and accurately identified.’

Health secretary Jeremy Hunt said the ‘rigorous’ new inspection regime for general practice would tackle the ‘unacceptable variation’ across the country.

But Sean Duffy, national clinical director for cancer at NHS England, said data such as these could be ‘difficult to interpret’, and ‘isn’t a clear measure of how good a GP practice is at spotting cancer’.

Many patients do not visit their GP with symptoms, and so cancers are often only detected when patients present to A&E, he said.

‘In fact, it tells us more about how the system is working as a whole. Patients who are well-informed about potential cancer symptoms and can access their GPs and community services easily, are more likely to act on early symptoms and be referred on the two-week pathway.’

Data not straightforward

Dr Nagpaul said ‘simplistic league tables’ failed to show the complexity of diagnosing patients. ‘There are dangers of simply looking at headline figures without trying to understand the underlying causes, and we must remember that survival rates are not an indication of GP referral rates but much wider issues,’ he said.

‘While it is easy to make a diagnosis with the benefit of hindsight, it is important to recognise that many cases of cancer by their nature can be deceiving by not presenting with clear signs or symptoms, and can mimic less serious illnesses.'

He added: ‘The priority should be to understand what lessons can be learnt from the appropriate use of this data, and to identify better ways and systems to ensure patients with suspected cancers are picked up and treated as early as possible. It is important that this data is used not to unreasonably penalise GPs who are working hard to deliver consistently high standards of care to patients.’ 

The NHS Choices website says low percentages of patients referred through two-week-wait 'may indicate that GPs are not identifying symptoms that may show cancer and referring patients accordingly'.

But it adds that patient characteristics such as age or deprivation can influence practice performance. 'Similarly, a practice’s performance on an indicator can sometimes be influenced by other organisations that are caring for the same patients – local hospitals or community services, for example.'

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