In England, the referral system for family doctors delayed cancer diagnoses
In England, the system of consultations between general practitioners and specialists may, in some cases, have contributed to missed or delayed cancer diagnoses. This is according to the findings of the Health and Social Care Safety Investigation Board (HSSIB), as reported by The Guardian World.
The Advice and Guidance (A+G) service was introduced so that general practitioners could seek specialist advice before referring a patient to a hospital. The system was intended to reduce the number of unnecessary hospital visits and shorten wait times. The HSSIB noted that the service improved communication between general practitioners and consultants and ensured more effective involvement of specialists in patient care.
At the same time, the investigation found evidence that, if improperly implemented or monitored, A+G could be linked to cases of potential harm to patients—both physical and psychological. The report states that the harm resulted from delayed or missed diagnoses, as well as delays in medical care and treatment.
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The HSSIB found that in some clinical pathways, A+G was used even when a general practitioner had requested a specialized examination of a patient with suspected cancer. The documented incidents indicated that this practice contributed to delays in diagnosis. In some regions, doctors were required to use A+G instead of direct referrals, and some referrals were rejected despite doctors’ concerns about patients’ conditions.
The agency recommended that NHS England and the UK Department of Health and Social Care urgently assess the operation of A+G. In particular, it recommended addressing issues related to system resources and capacity, staff training needs, and reports of incidents related to patient safety.
A Pulse survey of 712 general practitioners found that approximately one-quarter of patient referrals are rejected and returned as unsolicited A+G requests. Doctors also reported that in 36% of the A+G requests they received, they were asked to perform tasks they considered outside the scope of their duties.
