On 16.11.22 NHS England announced this new service: https://www.england.nhs.uk/2022/11/nhs-gives-gp-teams-direct-access-to-tests-to-speed-up-cancer-diagnosis/
What
All GPs in England will now be able to refer suspected cancer patients for tests without them first having to see a specialist under an NHS initiative designed to speed up diagnosis.
The scheme, which starts this month, will let family doctors send patients with potential symptoms straight to have a scan, X-ray or other diagnostic test.
Why
Lasted government data shows currently 60.5% of patients start treatment for cancer within 62 days (about 2 months) of GP referral (the target is not that high, at 85%). This is a poor performance by the NHS by any standards. So, anything we can do to improve this is a good thing. This new service is an attempt to do that.
There is a currently a system called Two Week Wait (2WW) that runs reasonably well. GPs can activate it, when they suspect cancer. It states that a patient with suspected cancer should be seen by the relevant specialist within 2 weeks of GP referral; often via having the key test on the way – e.g. a colonoscopy on the way to see a bowel surgeon, when the patient has suspected bowel cancer.
Nonetheless, it is possible (with this new system) that tens of thousands of cases of cancer could be detected earlier as a result of the new approach; which is intended to help improve Britain’s poor record on early diagnosis.
It is aimed at ensuring that the 67,000 people a year who have possible but vague signs of the disease – such as a cough, fatigue or dizziness – and are classed as non-urgent for testing purposes, no longer face long delays before getting tested.
How (does it affect you)?
It may mean, in England, that if your GP suspects cancer, you will get the key test sooner, and not wait to have to see a hospital consultant (who then requests it). Then, if its positive, you can be fast-tracked to see them by the 2WW system, and then start treatment earlier. This could advantage you.
What is an alternative view?
It is not that simple (“it never is!” MyHSN Ed). GPs are now concerned that, in future, they will not be able to do a 2WW referral until after they have done a variety of tests. They are not specialists, and do not always know which test is best. The new system may create a 7 stage process – rather than one, where hospital admin staff do the chasing – involving significantly more clinical responsibility, work and admin tasks for the GP:
- Arrange the test (for which a waiting list will soon develop)
- Chase that appointment for that test for the patient
- Chase the reporting of the test
- Look at the result of the test
- Interpret it (for which they are not trained) .. then discover its the wrong test (and start again .. back to 1)
- Refer to relevant specialist (who may reject the referral, as the wrong test has been done, back to 1)
- Chase that appointment.
In other words, it is passing more work and responsibility back to a primary care workforce that is not coping with its workload. Conceivably it could actually delay the ’tissue diagnosis’, which is vital in cancer care.
Also, cynically, it could be interpreted as a way of reducing 2WW referrals, to ‘massage’ the 62 day data; actually lengthening the process, without true health gain.
This graph summaries the increase in numbers of hospital consultants vs GPs in recent years.
Number of GPs vs Hospital Consultants
As always, best wishes from myHSN!
