Direct access testing - allowing GPs to refer patients for diagnostic testing without first referring to or consulting with a specialist - performs ‘as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing and patient and GP satisfaction’, a systematic review of 60 studies has concluded.
Earlier this year, a GPonline poll revealed that nearly half of GPs have had a referral on the two-week cancer pathway bounced back or downgraded to non-urgent - often for patients later found to have cancer. It was also found that GPs were being denied direct access to testing despite repeated warnings from charities and NHS officials over the importance of rapid diagnosis.
Research by a team from Oxford University, published in the British Journal of General Practice (BJGP), dismissed claims that direct GP access to tests can increase numbers of unnecessary tests.
Although the authors found ‘no significant difference’ in the proportion of patients diagnosed via GP direct access referrals and the proportion of patients who were diagnosed following a consultation with a specialist, the waiting time for testing was found to be significantly shorter in patients seen by GPs with direct access to testing (mean 31.9 days), compared with those who had to be referred to a specialist (mean 76.6 days).
However, despite this reduction in patients’ time to testing there appeared to be no corresponding reduction in time to diagnosis, the researchers found.
GPs and patients reported high satisfaction with direct access testing, with the majority of patients saying that they felt seeing a specialist prior to testing was ‘not necessary’. Although 80.9% of referrals for cancer scans by consultants were found to be appropriate compared with 66.4% by GPs, the researchers said the difference was 'not significant'.
The authors said: 'This review has re-emphasised the importance of a whole-pathway redesign, and the need to focus efforts to reduce diagnostic delay on all intervals between symptomatic presentation to GP and final diagnosis.’