Widen GP referral criteria for suspected bowel cancer, charity urges

NICE should 'liberalise' referral guidelines for suspected bowel cancer so GPs can refer lower-risk patients for colonoscopy to improve early diagnosis rates, a charity has said.

Colonoscopy: call to allow GPs to refer more patients (Photo: SPL)
Colonoscopy: call to allow GPs to refer more patients (Photo: SPL)

Current NICE guidelines restrict GP urgent referrals to patients with high-risk symptoms, such as rectal bleeding, but these are only present in half of patients with bowel cancer, according to Bowel Cancer UK.

In a new report, the charity called on NICE to 'liberalise' its urgent referral pathway for suspected bowel cancer so GPs can refer patients with lower levels of risk than currently apply.

NICE said it was working on new guidance that would make it easier for GPs to investigate symptoms.

The report, Diagnosing bowel cancer early: right test, right time, found widespread issues with access to colonoscopy and flexible sigmoidoscopy in the UK, including a lack of investment in capacity by CCGs and delays to patients accessing diagnostics.

Widening referral criteria would increase demand but is necessary to ensure patients are referred sooner, the report said.

It also raised concerns 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 for endoscopy services to meet this rising demand.

Waiting times breached

The report found patients in Wales are waiting the longest for colonoscopy, with 15% waiting 8-14 weeks and 26% over 14 weeks. In Northern Ireland, all six trusts failed to meet a target that no patient should wait more than nine weeks, while in Scotland 6.8% of patients are waiting longer than the recommended six-week waiting time target.

In England, however, less than 2% waited more than the recommended waiting time.

Deborah Alsina, chief executive of Bowel Cancer UK, said: 'We are calling for GP guidelines to be liberalised so that GPs can use their judgement and refer patients even when their symptoms do not point directly to bowel cancer.  It’s a tragedy that more people are not referred for endoscopy sooner.  After all, early diagnosis saves lives.'

NICE is currently updating its guidance for GPs on the recognition and management of suspected cancer in light of new evidence, and draft proposals are expected in November.

A NICE spokeswoman said: 'We recognise the desire for a more symptom-based approach towards referring people with suspected cancer and it is intended that our updated guidance will be structured around the signs and symptoms of cancer to help make it easier for GPs to consider the possibility of cancer in a patient and aid rapid diagnosis.'

Over 40,000 people are diagnosed with bowel cancer each year in the UK.

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