GP cancer guidelines should be 'liberalised' for easier referrals

GP cancer guidelines should be 'liberalised' for easier referrals

The report Diagnosing bowel cancer early: right test, right time* says GPs should be allowed more freedom to refer patients for endoscopy investigations.

The current guidelines from NICE do not work well enough, said the charity, which said there were delays in referral for diagnostic testing caused by overly-prescriptive guidelines and a lack of investment in endoscopy capacity by CCGs that was failing to meet future demand.

An estimated 15,700 people die of bowel cancer every year in the UK, making it the second most common cause of cancer death in the UK, and more than 40,000 people are diagnosed.

In the report, Bowel Cancer UK presented findings from its national survey of 708 people with bowel cancer who had had an endoscopy.

Amongst those people, a third had seen their GP more than three times before being referred and of these, nearly half had a tumour detected.

More than a million (1.12m) endoscopy procedures were carried out in 2013-14 in the UK and this number is set to rise to 1.48m in 2016-17.

The report says there is a serious problem with the current national guidance for GPs on referral of urgent suspected cancer, which restricts referral to those with “alarm” or “high risk” symptoms, such as rectal bleeding.

However, only half of people diagnosed with bowel cancer present with the “high risk” symptoms that would qualify for an urgent referral for diagnostic tests such as a colonoscopy or flexible sigmoidoscopy.

Deborah Alsina, the charity’s chief executive, said: “We are calling for GP guidelines to be liberalised so that GPs can use their judgement and refer patients even when their symptoms do not point directly to bowel cancer.

“It’s a tragedy that more people are not referred for endoscopy sooner. After all, early diagnosis saves lives.”

The report also says waiting times for endoscopies are an issue because some people are waiting significant lengths of time between being referred and having their test.

Waiting times in Wales were particularly poor with 15% of patients waiting between 8 and 14 weeks and 26% waiting over 14 weeks for a colonoscopy, said the charity, while in Northern Ireland, no trusts there had met the target of no patient waiting more than nine weeks.

Performance in Scotland had dropped, with 6.8% waiting longer than the recommended six week waiting time target there, compared to less than 2% in the previous month.

However, figures for England were more encouraging, as less than 2% of patients were waiting more than the recommended waiting time.

Ms Alsina added: “Waiting times for some patients in parts of the UK, such as Wales, are bordering on scandalous.

“We can’t increase waiting times as many people are already waiting too long, so CCGs need to commission more endoscopy capacity and endoscopy units need to ensure they are as efficient as possible so they can perform more endoscopies.”

By Adrian O'Dowd

OnMedica, Wednesday 28th May, 2014

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