Pressure on GP referrals linked to higher cancer mortality

Pressure on GPs to avoid over-referral may be driving high UK rates of mortality from colorectal cancer, research has warned.

GP referral: pressure on GPs (Photo: JH Lancy)
GP referral: pressure on GPs (Photo: JH Lancy)

Concerns over the consequences of over-referral may be stopping some GPs from referring patients for suspected colorectal cancer, a study published in the British Journal of General Practice (BJGP) has found.

The pressure is compounded by the presence of referral league tables and fear of criticism from healthcare commissioners, the researchers added.

Structured interviews with 18 GPs and 12 practice managers were carried out to ascertain barriers and facilitators to GP referral of patients meeting NICE guidelines for urgent referral for suspected colorectal cancer.

They identified four key barriers to early referral, including resource constraints, poor knowledge of NICE criteria, not wanting to scare a patient and acceptance and normalisation of anaemia.

Colorectal cancer

Resource constraints ‘perceived to come from CCGs’ made some doctors ‘think twice about referring’, they said.

Respondents said the message of reducing ‘unnecessary’ referrals was often in the back of their minds when seeing patients.

Annual incidence of colorectal cancer occurs at 66 per 100,000, meaning a full-time GP can expect to see around one case per year – and may be unfamiliar with the many possible symptoms.

Mortality from colorectal cancer in the UK remains higher than in comparable countries, partly due to diagnosis and treatment at a later stage. Concerns about timely referral for patients who meet urgent referral criteria have been raised.

The authors concluded: ‘These data indicate that GPs in the current study were often reluctant to refer these patients for a variety of reasons. They were aware of pressure to avoid over-referral and wished to avoid being identified as having a high referral rate. Some GPs considered that referral would scare patients and weighed this against a low perceived risk of cancer.’

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