Some GP practices are still failing to refer potential cancer patients for early tests and could be responsible for thousands of deaths
Thousands of cancer patients are dying needlessly because GPs did not refer them for fast track appointments, new research suggests, amid fears that doctors are still not complying with guidelines.
Almost 2,500 people might still be alive if family doctors had used a two week urgent referral pathway, a key part of the strategy to cut deaths in England, Kings College London has calculated.
A study published in the British Medical Journal compared practices, their rates of urgent referrals and survival rates between 2009 and 2013.
It found just one in six surgeries had a high use of the initiative while those with the lowest referrals had death rates which were seven per cent higher than the best performing practices.
In June, the National Institute for Health and Care Excellence (Nice) issued new guidelines to help doctors assessing 37 different cancers so they could spot the signs more easily and refer patients more quickly while the new NHS cancer strategy, promised an 80 per cent increase in tests for diseases
But there are fears that doctors are still not using the pathway, with some being offered bonuses of thousands of pounds to reduce the number of cancer patients sent to hospital.
Research undertaken by Pulse magazine published earlier this month found that CCGs in nine parts of the country were offering GP practices financial incentives to cut referrals, including those via the two week cancer pathway.
Professor Henrik Moller, of King’s College London, urged doctors to urgently refer anyone they suspect of having cancer to improve survival rates. Early diagnosis of a disease nearly always means more effective treatment and better outcomes.
“Achieving an earlier diagnosis of cancer at a less advanced stage is a public concern and has become a widely adopted priority for healthcare systems,” said Prof Moller.
“It is generally assumed that the more promptly a diagnosis of cancer is made, the better is the prognosis, because cancer detected at an earlier stage has better treatment options leading to improved survival.
“General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer.”
The urgent referral pathway was implemented in England in 2000, but its use among general practices varies considerably and its impact on cancer survival was, until now, unknown.
Using national records on cancer waiting times, diagnoses and deaths, the researchers analysed data for 215,284 cancer patients from 8,049 general practices in England who were diagnosed or first treated in 2009 and followed up to 2013.
A study published last month showed the UK has the worst survival rates for cancer in western Europe, with rates a third lower than in Sweden.
Prof Moller estimated an additional 2,400 patients from low referring practices might have been alive after the four year study if use of urgent referral had been higher.
Prof William Hamilton, of the University of Exeter, said fast track referral is one part of an improving picture of cancer diagnosis in the NHS, and agreed practices with a consistently low use of the two week system “should consider why this is so.”
He said the study “adds further evidence to the survival and emergency admission figures, and all point in the same direction.”
Prof Hamilton said: “It is better to develop cancer in the United Kingdom now than it was ten years ago – and improved diagnostic facilities are a part of the reason why. It may be even better in another ten years.”