Cancer referrals vary widely in England

Doctor examining a patient
Credit: NCI

The number of referrals general practitioners (GPs) make for patients with suspected cancer varies widely across England, according to data collected by the National Cancer Intelligence Network (NCIN).

Researchers say the implications of this finding are not entirely clear. But the data seem to suggest there are different standards of care throughout England, and this issue should be addressed. 

“The data are not easy to interpret, since we do not know what the ‘optimum’ level is for these measures,” said Dr Mick Peake, lead clinician at NCIN.

“And 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.”

Dr Peake and his colleagues compiled information on referrals for patients visiting a majority of the practices in England. Some practices were excluded because their patient populations were too small or were changing too rapidly.

The data revealed a more than 3-fold variation in the rate of urgent referrals to hospital specialists for patients suspected of having cancer. Referral numbers ranged from less than 830 to more than 2550 in every 100,000 people a year.

The researchers also found a wide gap in the proportion of those patients referred who then went on to be diagnosed with cancer. The low was 2.3% in Hammersmith and Fulham, and the high was 15.6% in Herefordshire.

“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, also of NCIN.

“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.”

These data are now publicly available online. Users can look up the number of cancers diagnosed at a practice, the number of people who have screening, and the numbers sent through the 2-week wait referral system.

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