Information published by the National Cancer Intelligence Network (NCIN) reveals wide variation across England in the number of patients with suspected cancer who are referred by GP practices to secondary care.
Publication of this data marks the first time that information on cancer referrals from individual GP practices has been made available publicly. Among other things, it shows that the variation in the rate of urgent GP referrals to hospital specialists for patients with suspected cancer is more than threefold, ranging from under 830 to over 2,550 urgent referrals in every 100,000 people a year. It also shows a wide gap in the proportion of those patients referred who then go on to be diagnosed with cancer.
"The data are not easy to interpret, since we do not know what the 'optimum' level is for these measures," cautioned Dr Mick Peake, clinical lead for the NCIN. Also, "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," he added.
This information is now being made publicly available as part of the government's "open data" strategy. Anyone will be able to look up information about their GP practice, including the number of cancers diagnosed at the practice, the number of people who have screening and the numbers sent through the two-week wait referral system."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," said Di Riley, associate director for the NCIN's clinical outcomes programme.
"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," she added.
Cancer Research UK described the more than three-fold variation in the rate of urgent cancer referrals revealed by the data as "very worrying.""We already know that some patients present several times with cancer symptoms before being diagnosed for further investigation, which can lead to late diagnosis. And a delayed cancer diagnosis could prove critical for a patient's chance of survival," said Sarah Woolnough, the charity's executive director of policy and information.
However, Professor Clare Gerada, chair of the Royal College of General Practitioners (RCGP), pointed out that the College's first-ever 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 and that nearly 60% of all patients referred attended secondary care within two weeks.
"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," said Prof Gerada. "There is no doubt that giving GPs greater and improved access to cancer tests would be a major step forward," she added.Every year, the average GP will only see seven patients who have cancer. These break down as one case each of breast, bowel, prostate and lung cancers, plus three cancers of other types, notes the NCIN.