GPs criticise 'misguided' DH plan to name practices with low cancer referral rates

GP leaders have criticised a 'simplistic and misguided' plan by the DH to 'name and shame' GP practices with low cancer referral rates, warning it could increase unnecessary referrals.

Dr Chaand Nagpaul: cancer ranking plan is 'simplistic and misguided' (Photo: Pete Hill)
Dr Chaand Nagpaul: cancer ranking plan is 'simplistic and misguided' (Photo: Pete Hill)

Under a plan attempting to reduce regional variations in diagnosis, practices will be ranked as 'red' for cancer care on the NHS Choices website if they have lower rates of referral for suspected cancer, according to media reports. Those with higher rates will be marked as 'green'.

The RCGP warned that the ranking system would be a 'crude' measure of GP performance, while the GPC said a rise in unnecessary referrals prompted by the scheme could saturate services and delay patient care.

Health secretary Jeremy Hunt announced the initiative in an interview with the Mail on Sunday. He said: ‘We need to do much better. Cancer diagnosis levels around the country vary significantly and we must do much more to improve both the level of diagnosis and to bring those GP practices with poor referral rates up to the standards of the best.’

Responding to the media reports, Dr Richard Roope, RCGP clinical lead for cancer, said:  'We know that we can always improve but using crude ranking systems to measure our performance and ability to care for our patients may not tell the whole story.

'A scheme like this might look like a beneficial initiative at face value, but the data that would be used to inform such ratings would be very complex and should be approached with caution. The rankings could be misinterpreted according to the specific characteristics of patients in particular areas, for example, where there are high levels of deprivation.'

He added: 'We should be supporting GPs, not criticising them.'


Dr Chaand Nagpaul, GPC chairman, said: 'Naming and shaming GP referral rates is simplistic and misguided and will promote a blame culture, rather than the learning culture needed in the NHS to improve the detection of suspected cancer.'

He said it would not improve detection rates or management. 'It will also be counterproductive by encouraging GPs to refer everyone which would clog up hospital clinics and delay diagnosis and treatment for patients in genuine need, and who would wait longer for an appointment to see their specialist.'

Dr Nagpaul said the government should instead look at improving public awareness and education of the signs and symptoms of cancer to encourage people to visit their GP earlier, and increase cancer screening uptake. Referral systems between GPs and specialists must improve, he added.

Concern over diagnostic capacity

Concerns have been raised in recent years over the capacity of NHS diagnostic services to absorb rising demand.

In May, Bowel Cancer UK warned about the capacity of existing endoscopy units to cope with the additional 350,000 procedures expected over the next three years. They called on CCGs to increase funding.

Three-quarters of patients with cancer are referred within one or two GP consultations, according to RCGP figures. The average full-time GP will see eight new cancer cases among their 8,000 patient consultations per year.

A DH spokeswoman said the proposal would be part of ongoing work to benchmark practices to drive up standards and that further details of how this particular scheme would work would be published later in the year.

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