A study conducted by BMJ Open has revealed that a lack of access to CT and MRI imaging is leading to GPs in the UK referring patients with suspected cancer much later than their counterparts in mainland Europe.
Doctors taking part in the study across the continent were given a scenario of a patient presenting with symptoms associated with cancer, but also other non-cancerous disease. 61% of doctors in continental countries said that they would refer for cancer screening immediately, whereas only 38% of GP’s in the UK would make the referral in the first instance.
GPs are often referred to as the “Gatekeepers” of the NHS; responsible for only referring patients for necessary investigations and treatment. It is an important job, as the NHS clearly does not have the resource to provide its services when there is no clinical need. However, are the pressures placed on GPs to cut referrals leading to more cautious practice when it comes to cancer referral, and is this having an effect on life expectancy and quality of life of those eventually diagnosed with the disease?
In this particular study, survival rates of a year or more following diagnosis were 8% lower in the UK than the average in the rest of Europe. It can only be assumed that this is due to delayed treatment, which has allowed the disease to progress to a more dangerous stage.
Many clients come to Clarke Willmott’s Clinical Negligence team because they or a loved one had not been diagnosed with cancer at an earlier opportunity when, in theory, they were displaying classic symptoms of the disease. It would seem logical that a GP could be held to be negligent if they do not refer a patient for cancer screening the moment they display symptoms that could indicate presence of the disease, especially given that in some cases the golden ticket to cancer survival is known to be early intervention. However, GPs, like all other doctors, can only be judged against the practice of a reasonable body of GPs in the UK. If that reasonable body would not have referred any earlier, due to the lack of scanning facilities and pressure to keep patients out of hospital unless necessary, then it is possible that no negligence will have occurred.
In other words, a GP can only be as good as the system that they work within. If it is the NHS policy to exhaust other avenues before referring for scans, even when the patient is showing symptoms that could indicate cancer, then a GP can only be expected to follow that system.
What this study indicates is the need for more CT and MRI scanning available to GP’s, and an eradication of the culture present in the UK that GPs should be limiting the use of hospital resources where there is a real risk of a patient suffering from life threatening illness.