An investigation undertaken by the GP magazine Pulse has found that GPs are being offered financial incentives to cut the number of patients being referred to hospital for specialist cancer treatment.

The purpose of the financial incentives is, allegedly, to limit the number of patient referrals in order to save costs. A minimum of nine of the Clinical Commissioning Groups were found to be offering this type of payment to reduce the number of outpatient appointments, follow-up appointments, A&E referrals and emergency admissions. 

Cancer treatment – guidelines and practice

The most alarming part of the survey is that this includes patients who require consultations with specialists, and is therefore likely to include those who have suspected cancer. With early diagnosis and treatment to critical to good outcomes, this is a huge cause for concern.

Despite the national drive to educate people about the warning signs of cancer, restrictions on referrals for financial reasons could render this could work all but redundant in many cases.

The most obvious example is referrals for breast cancer. It is now commonly understood that, where a woman has a lump in her breast, this needs investigating. The NICE guidelines for suspected breast cancer dictate that a referral should be made to a specialist within two weeks in patients with the following symptoms:

  • Those over 30 with an unexplained breast lump
  • Those over 50 with discharge, retraction or other changes of concern in one nipple only
  • Those with skin changes that suggest breast cancer or 
  • Those aged 30 and over with an unexplained lump in the axilla. 

The NICE guidelines go further, suggesting that those under 30 with an unexplained breast lump should be referred on a non-urgent basis.

A worrying scenario for patients

In response to the investigation, one Clinical Commissioning Group said that it was 'confident that there is no conflict of interest'.  However, if GPs are being paid to significantly reduce the number of referrals, in contrast with their obligations under the NICE guidelines set out above, how can there be a consistent, fair and, above all, safe system for early management of cancer? As Dr Rosie Loftus, who works with the Macmillan Cancer Support Charity, said that the findings of this study are 'very worrying'.