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Variation in GP cancer referrals identified

Three fold variation in GP referrals must be addressed

Adrian O'Dowd

Wednesday, 01 August 2012

Cancer experts say there is a wide variation in the number of patients that GPs refer with suspected cancer, which could indicate different standards of care around England.

From this week, the National Cancer Intelligence Network (NCIN) is publishing information on its website on cancer referrals from individual GP practices – the first time that this information has been made available publically.

The first data shows wide variation across England in the numbers of patients with suspected cancer that GPs are referring to secondary care.

The rate of urgent GP referrals to hospital specialists for these patients is more than three-fold, ranging from under 830 to over 2,550 urgent referrals in every 100,000 people a year.

Data also shows a wide gap in the proportion of those patients referred who then go on to be diagnosed with cancer.

The average GP will see seven patients who have cancer each year.

The NCIN said these data were valuable to practices, which could use them to benchmark the outcomes of their patients. Making them available publically was part of the government’s open data strategy.

Anyone can look up information about their GP practice including:

  • the number of cancers diagnosed at the practice
  • the number of people who have screening
  • the numbers sent through the two-week wait referral system.

Dr Mick Peake, clinical lead for the NCIN, said: “The data are not easy to interpret since we do not know what the ‘optimum’ level is for these measures and although the data are adjusted for age, there may be other differences in the characteristics of the patients of a particular GP practice that impact on local referral rates.

“However the range of the variation is so wide that, at the extremes, it probably reflects differing standards of care.”

Di Riley, associate director for the NCIN’s clinical outcomes programme, added: “Although the number of people GPs refer isn’t on its own an indicator of how good they are at spotting the early signs of cancer, it’s clear from these data that there’s variation that needs to be addressed.

“It’s important to remember that GPs have a hard job and many of the symptoms of cancer are very similar to many other illnesses. But we must do more to understand the reasons for the variation.”

RCGP chair Professor Clare Gerada welcomed the availability of more information, but defended GPs’ record on spotting cancer.

“These practice profiles contain a wealth of information about the important contribution that GPs make to saving lives from cancer,” she said.

“The RCGP’s very first audit of cancer diagnosis in primary care published last year revealed that over 70% of patients visiting their GP were referred to a specialist after one or two consultations.”

However, she added: “There are some patients where we do, for various reasons, have difficulty in making a rapid diagnosis and we must always be looking at how we can do better and do more. There is no doubt that giving GPs greater and improved access to cancer tests would be a major step forward.

“The college has identified cancer as its first ‘enduring’ priority to look at how we can help GPs build upon their existing skills to diagnose cancer earlier and provide the best possible quality of care to patients who have cancer.”

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