The role of NHS gatekeeping in delayed diagnosis

Yet again the myth that poor cancer outcomes are the fault of GPs is repeated in the BMJ. I pointed out 2 years ago (http://www.bmj.com/content/344/bmj.e3017/rr/583036) in response to Day's article [1] that there is evidence to the contrary. He stated that "one in three patients was not initially referred for a hospital appointment, with one in five seeing their general practitioner three or more times before a referral was made."

This actually means that two thirds of cancer patients are referred immediately and four fifths after three or less consultations. Increasing referrals for suspected cancer cases, by lowering the threshold, would swamp a system that is already creaking at the seams. This would increase delays in secondary care and worsen outcomes.

Is cancer care that much worse in the UK than elsewhere? Or is our comprehensive recording systems that capture every last case making it look worse than other countries with less complete data? If there is a genuine disparity the cause does not lie in Primary Care.

1. BMJ 2012;344:e3017