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“Thousands dying” because GPs fail to refer patients

The Daily Telegraph recently reported on the growing problem of GP referrals for cancer in England – including new research suggesting that thousands of cancer patients are dying needlessly because GPs do not refer them for fast-track appointments, in spite of guidelines being in place encouraging them to do so.

The research, published in the British Medical Journal, and led by Prof Henrik Møller of Kings College, London, set out to “assess the overall effect of the English urgent referral pathway on cancer survival”. The cohort study looked at 8,049 general practices in England, linking information from the national Cancer Waiting Times database, NHS Exeter database, and National Cancer Register. This information was used to estimate mortality in patients in relation to the propensity of their general practice to use the urgent referral pathway. In total, 215,284 patients with cancer, diagnosed or first treated in England in 2009 and followed up to 2013, were included in the study.

 

It was found that during four years of follow-up, 91,620 deaths occurred, of which 51,606 (56%) occurred within the first year after diagnosis. The hazard of death was 4% lower for the 16% of patients from practices with high use of the urgent referral pathway, and 7% higher for the 37% of patients from practices with low use compared with the 47% of all patients from practices with intermediate use.

In its report, the Telegraph highlighted a further complicating factor: the fact that CCGs (clinical commissioning groups) were offering GPs bonuses for staying within their targets – essentially paying them to reduce the number of patients they refer.

Gordon Wishart, Professor of Cancer Surgery and Medical Director of Check4Cancer, comments:“The UK now has some of the worst survival rates for cancer in western Europe. A key problem is that we have a conflicted health service, seriously under-resourced and having to make cuts, whilst the demand for its services is constantly growing. For example, according to research by Breast Cancer Care the number of newly diagnosed breast cancer cases has risen by a fifth in the last decade, yet in that time there has been no rise in the number breast cancer nurse posts. There are new measures being trialled at five hospitals to drive up faster diagnoses, but more needs to be done. There is an opportunity here for employers to help by offering their own checks, to protect their workforce and in doing so safeguard their businesses.”

Troels Jordansen, Managing Director of Check4Cancer adds: “The incidence of cancer has steadily risen in recent years, to the extent that one in two people born after 1960 are now expected to suffer the disease at some point in their lives. This means more people than ever are turning up at GPs surgeries with undiagnosed cancers. As the name ‘general practitioner’ suggests, however, GPs are not cancer specialists. This is one of the reasons we established Check4Cancer: to make cancer-specific checks – designed and implemented by world-leading specialists in the field – more widely available. These can also be offered in the workplace as a benefit, targeting groups most at risk of particular forms of cancer, which means cases can be caught even before symptoms arise, and referrals made quickly where results indicate this is necessary. This can help relieve some of the pressure from GPs and the NHS – but most importantly, can help to save lives. The ways we approach and deal with cancer are changing, and employers are beginning to appreciate the threat that cancer poses to their businesses if they fail to act.”

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