Viewpoint: Denying GPs direct access to cancer scans puts patients' lives at risk

GPs need the freedom to manage patients with suspected cancer based on risk and need, warns Cancer Research UK GP expert Dr Richard Roope. Writing for GPonline, he says the findings from our latest opinion poll are worrying and disappointing.

Cancer Research UK GP expert Dr Richard Roope
Cancer Research UK GP expert Dr Richard Roope

Earlier diagnosis of cancer can save lives. Tens of thousands of patients are diagnosed with late stage cancer each year1, which may limit their treatment options and success.

While primary care is not the only area which needs greater focus to improve early diagnosis, GPs are paramount. It’s important they have the right options to manage and refer patients when necessary.

It’s worrying that the latest GPonline survey suggests that patients, once referred, may get neither tests nor their results as promptly as they should. But perhaps what may be just as concerning is the lack of capacity influencing patient management and referral in the first place. We need GPs to be free to manage patients based on risk and need – it’s unacceptable for them to be deterred from following professional guidelines which offer cancer patients the best chances.

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In 2015, two initiatives aimed to equip GPs with more tools for early cancer diagnosis in the form of suspected cancer recognition and referral guidelines were published. These included direct access tests when a patient presents with symptoms and signs which might not warrant an urgent cancer referral, but still cause concern, meaning more people with symptoms are investigated.

If direct access tests aren’t available for GPs, it may mean they can’t follow the NICE guidelines, and their patients might miss out on life-saving tests. The GPonline survey highlights that there is still variation in these tests being offered, which is disappointing seven years after the first DHSC guidance.

Diagnostic capacity

Summer 2015 also saw the publication of the latest cancer strategy in England, which prioritised early diagnosis and flagged how crucial diagnostic tests are in achieving this. It noted that with the use of the NICE referral guidelines, more diagnostic capacity would be needed.

This growth was not insignificant; Cancer Research UK’s own modelling showed that 750,000 more endoscopies will be needed every year in England by 2020 – an increase of 40% on 2013/14 activity levels. As a result, the government committed to boosting investment in these services. This commitment was followed by planning guidance highlighting the need for CCGs to meet growing demand for diagnostic services.

Yet we still hear that diagnostic services are under pressure. This may result in pushbacks on referrals, and, worryingly, people may not get the tests they need. We know that departments dealing with imaging, endoscopy and pathology are all short staffed, so funding is needed for more activity. Boosting recruitment and retention of essential doctors, nurses and allied health professionals will help.

To achieve world-class cancer outcomes, improving early diagnosis and access to treatment are key. These need both the right workforce and resources as well as giving GPs the best access to diagnostics. This will ultimately both improve outcomes and save money. A win-win for both the patient and the NHS.

  1. National Cancer Registration and Analysis Service: survival by stage

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