Cost cutting pressures result in GPs being unwilling to make urgent suspected cancer referrals

A study by Birmingham University has found that doctors are unwilling to make some urgent suspected cancer referrals because of a pressure to reduce costs.

Interviews with GPs revealed that many were reluctant to refer patients if they had any doubts on whether they had cancer and many were concerned about being regarded by health bosses as having too high a referral rate.

The study also revealed a lack of understanding amongst GPs in relation to the seriousness of several warning signs of colorectal cancer.

Study authors said “Red flag symptoms alone were not regarded as sufficient.  Anaemia was often perceived as common and therefore not always warranting investigation.

“Because of lack of familiarity with referral guidelines, some GPs used personally devised decision rules and diagnostic strategies which hindered further investigation.”

Chair of The Royal College of GPs, Professor Helen Stokes-Lampard, said of the findings “GPs are doing an excellent job of referring patients with suspected colorectal cancer earlier – and partly because of this, survival rates are increasing year on year.

“GPs will always act in the best interests of the patient in front of us – taking into account their unique circumstances.

“But we do face considerable pressure not to refer patients to secondary care, so it’s unsurprising that some GPs are cautious about making a referral unless they are confident that a patient clearly meets all the necessary criteria.

“With many symptoms of bowel cancer being very common, and similar to conditions of other, non-life-threatening conditions – and with clinical guidelines, quite rightly, being updated frequently as new evidence is taken into account, making this decision is not straightforward.”

Dr Sinead Clarke, Macmillan GP Advisor, said “It’s hugely concerning that this study suggests that GPs are deciding whether to send people for cancer tests with cost cutting in the back of their minds.

“We know GPs are under immense strain. Macmillan’s recent report revealed that 44 per cent of GPs and nurses surveyed said pressures meant cancer patients were not always being treated as early as they should be.

“Inadequate access to tests and treatment play a part in England’s poor cancer survival rates, which are among the worst in Europe.

“To ensure this doesn’t get worse, GPs must be given the vital resources and tools they need to provide the care that every cancer patient deserves.”

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Posted by Tony May, Partner/head of Clinical Negligence Department, Chadwick Lawrence LLP (tonymay@chadlaw.co.uk ), medical negligence lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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