Victoria is a PhD student who normally works on lung cancer research
Around a quarter of GPs have said that urgent referrals for suspected cancer had been inappropriately turned down by hospitals more often than before the pandemic.
Over 1,000 GPs across the UK were surveyed in June and asked to compare how the past month had differed to before the COVID-19 pandemic.
Experts believe the change is likely to be because of a lack of capacity and reduced access to diagnostic tests within hospitals. It’s also possible hospitals could have been trying to reduce exposure to COVID-19 that could occur if patients came to a hospital.
Lack of safety netting
When a patient goes to their GP with suspected cancer symptoms, they can be referred for further tests under an urgent suspicion of cancer pathway to investigate the symptoms further. The aim is either to confirm or rule out cancer.
These referral pathways, which differ slightly between nations, have been heavily affected by coronavirus.
In some areas, cancer referrals dropped by 75% at the peak of the pandemic, mainly because people weren’t coming forward with symptoms and staying home to protect the NHS.
But this survey shows that referrals being rejected was also a problem, with the impact varying in different regions of the UK. Up to 40% of GPs in some regions said they felt this was happening more regularly than before the pandemic.
Consultant can choose to downgrade the referral for various reasons, for example, they don’t think their symptoms warrant an urgent cancer referral or investigation. If this is the case, the consultant will have a discussion with the GP and proper safety netting is put in place for the patient. But sometimes a GP may disagree with the decision and consider it an inappropriate rejection.
Worryingly, nearly 40% of all the GPs did not feel that adequate safety-netting had been put in place, leaving patients in limbo between the GP practice and secondary care when referrals were rejected.
300,000 fewer urgent referrals
On average, around 233,000 people with suspected cancer symptoms are urgently referred for further investigation each month across the UK, and an estimated 16,300 of these people would turn out to have cancer.
But since the start of the lockdown, it’s estimated that there have been 300,000 fewer urgent suspected cancer referrals than normal.
“The NHS says it’s open for business, which remains a really important message to encourage people to come forward with symptoms,” said Mitchell. “So, we need to be confident that patients will receive the care they need and able to reassure people that they won’t be lost in the system that is also facing a mounting backlog.”
It’s important to still seek help
Dr Richard Roope, a Cancer Research UK GP, said that GPs are doing everything they can during these really difficult times and it’s alarming that referrals are being turned away.
“Waiting for further tests can be an extremely worrying time for patients. And in most cases, it won’t be cancer. But for those people who may be missing out on a potential cancer diagnosis, this is not OK. Those appointments that have been rejected need to be followed up.
“For patients with symptoms that are now thinking ‘what’s the point of getting it checked if nothing will be done?’ it’s important you still seek help, as it’s definitely better that your GP knows and can keep fighting your corner for you to be referred. Hospitals are now putting in secure systems to ensure that patients are followed up appropriately.”