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GPs unfairly attacked for missing cancer cases

BMA questions claims that half of cancer cases are missed by GPs

Adrian O'Dowd

Monday, 09 December 2013

Claims made that GPs are either missing more than half of all cancer cases or are too slow to spot them have been rejected by the BMA as being unfair and misleading.

New data from NHS England on around 4,000 GP practices in the country suggested that thousands of people who were eventually diagnosed with cancer were not referred to a specialist by their GP and symptoms were spotted elsewhere in places such as A&E departments.

Various national media stories focused on the data as evidence of GPs’ failings to spot symptoms of cancer and refer people on quickly to specialists.

However, the BMA questioned the findings while NHS England said the not all cancer patients went to their GPs and the figures were not a clear measure of performance.

The data emerged from the NHS Choices website which from 6 December started publishing 40 easily accessible indicators of the quality of care being provided by GP practices in national performance data.

The current NHS target is for 95% of patients with suspected cancer to be seen by a specialist within two weeks, but in about half of GP practices sampled by NHS England, fewer than half of patients on their lists who were later found to have the disease were referred to a specialist by their doctor.

Mark Flannagan, chief executive of charity Beating Bowel Cancer, said: “We know that most GPs are doing the right thing, but we still know of too many patients having to visit their GP on multiple occasions with symptoms that they fear were cancer, only to be dismissed until they became far worse.

“It is intolerable that patients who are presenting to their GP are not being referred fast enough to ensure any cancer is swiftly and accurately identified.”

Sean Duffy, national clinical director for cancer at NHS England, said: “Not all patients visit their GP about these [red flag] symptoms, and others may have cancer without developing specific symptoms.

“It is often the case that so-called ‘hidden’ cancers, for example pancreatic cancer are diagnosed through these other routes, as they don’t have such clear ‘red flag’ symptoms. So the data can be difficult to interpret, and isn’t a clear measure of how good a GP practice is at spotting cancer.”

The BMA rejected the interpretation of the data in the media and chair of the BMA’s GP committee Dr Chaand Nagpaul, said: “GPs play a vital role in spotting cancer, and in looking after and supporting their patients throughout stressful times in their lives.

“However simplistic league tables fail to show the complexity of this process. There are dangers of simply looking at headline figures without trying to understand the underlying causes, and we must remember that survival rates are not an indication of GP referral rates but much wider issues.

“Many cases of cancer by their nature can be deceiving by not presenting with clear signs or symptoms, and can mimic less serious illnesses.

“The priority should be to understand what lessons can be learnt from the appropriate use of this data, and to identify better ways and systems to ensure patients with suspected cancers are picked up and treated as early as possible. It is important that this data is used not to unreasonably penalise GPs who are working hard to deliver consistently high standards of care to patients.”

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