Lansley’s pledge on cancer – more headlines over substance?

Dr Asif Sange believes the practicalities of Andrew Lansley's pledge to give GPs more access to direct diagnostic tests needs to be examined in further detail.

Today’s papers report the number of patients forced to wait more than six weeks for cancer tests has almost doubled in the past year, with charities warning cancer care my be damaged by Andrew Lansley’s NHS shakeup; Dr Asif Sange, who practices at the Royal Liverpool and Broadgreen University Hospital Trust and is an aide to Lord Patel of Blackburn, looks at the health secretary’s cancer pledge, announced yesterday

The health secretary’s pledge to give GPs more access to direct diagnostic tests in order to combat the UK’s high cancer rates makes for interesting reading. As with most of the coalition’s announcements, however, one has to look into the detail and the practicalities on the ground.

At present there is a two-week referral pathway for most patients seen by GPs, suspected of having cancer, to be seen by a hospital specialist. I have recently worked in head and neck surgery and patients suspected of cancer are seen and have the appropriate scan with results normally the same day. This worked because different specialists (eg a surgeon and a radiologist) were working together.

This two-week target was introduced under the last administration, and although I am not personally a fan of a blanket target approach, this is one area in the NHS where undoubtedly the approach has been successful. The coalition has mooted in recent weeks its disdain for targets and plans for abolishing them; the first question is whether they intend for this particular target to remain.

Secondly, although it is a good idea to open up diagnostic tests to GPs, the concern has to be the cost effectiveness of such an approach. GPs are generalists and the concern is whether their training or expertise will allow them to order such tests effectively or are we just going to increase the costs of expensive tests just because they are available?

The danger is GPs may order more tests without necessarily picking up more cases of cancer. The problem with this also is that the ‘specialist’ with years of experience in a particular area may well be bypassed before expensive tests are ordered.

Furthermore some tests – for example for bowel cancer – which involve visualising the bowel with a camera, are being proposed by the health secretary as something GPs can also access directly. Cost effectiveness aside this test is done practically by a specialist in hospital, thereby increasing the risk of prolonging waiting times for such procedures.

Some would argue that the simple answer is to increase capacity in secondary care, with more specialists and more tests carried out in hospital. This would mean we could have patients suspected of cancer being seen in a week or even the next day – wouldn’t this be more logical?

The danger with Mr Lansley’s proposals are that, although the intention may be noble the practicalities on the ground may not yield the results he desires. Specialists cost more money; just ordering more tests, however, may play well to the gallery but end up costing more and putting more inadvertent pressure on the NHS.

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