Having direct access to ‘fast-track’ cancer tests will make matters worse for both GPs and patients, argues Dr Tony Copperfield
I realise there’s no pleasing some, especially me. But am I alone in feeling a bit queasy about the latest plans enabling all GPs to order MRIs, CTs et al? There has been a reflex sense of jubilation among some that makes me wonder whether we’re aligned, planet-wise.
I didn’t even have to think about this – the following 10 drawbacks to this initiative just popped unbidden into my head.
1. It will stoke patient demand.
2. I will no longer be able to defuse or deflect that demand by explaining that a scan will in fact require a specialist referral.
3. I am not trained in knowing exactly what type of scan is appropriate for what type of problem.
4. Even if 3 was resolved, I remain not trained in knowing how to interpret the results of these scans.
5. It will increase indiscriminate scanning, partly because of the above but also because the frontline is increasingly run by test-trigger-happy noctors, though I accept that GPs are perfectly capable of investigative brain-farts, too.
6. Increased scanning will increase the incidence of incidentalomas, fuelling patient anxiety.
7. There will be no doubt who is responsible for the interpretation and management of these incidentalomas – there’s no point me bouncing them back to myself.
8. I will retain all clinical responsibility for cases which would otherwise have been diluted out by referral.
9. If the scan is negative, not knowing what to do will be my problem rather than the specialist’s, and if I end up referring anyway then I have simply delayed the patient’s entry into secondary care.
10. 1,2,5,6 and 7 of the above will simply increase scan waiting times, defeating the object. And this will then be my fault, according to the patient, as I am the scan gateway/pathfinder.
So, personally, I see this marvellous new fast-track access as making matters worse for GPs and patients. It smells like another rushed, ill thought-out, bolt-on, populist scheme, the funding for which could and should have been used to make the current, more rational system work properly.
Then again, you could say I’m so negative I need my head scanning. If so, I know who to speak to.
Dr Copperfield is a GP in Essex. Read more of his blogs here
Spot on TC, I share your queasy scepticism and sense of foreboding.
I agree. It’s a lobster trap.
They are penning you in, closing the patient around you. They’re blocking referrals, and scapegoating you again. Add to that, they will see the scan on their phone, in anatomical jargon, and you’re delivering *free follow-up* and accountability, bleeding your continuity which they never cared for – then CQC will hammer you for not having a new recall MRI CT policy, whilst GovUk is cunningly saving on hospital outpatient tariffs. Get some air while you can. This is a genius trap. With the narrative of helping the public, and shafting you.
I don’t agree with Tony, as much as I adore his wit: it is not that difficult to interpret scans, if you arrange them for the correct reasons. Often this is for a surgical indication only, otherwise don’t do it. Resolves the issue. However, for cancer referrals this can become quite tricky when you have to chase up a coordinator for cancers of unknown primary origin – that requires a separate coordinator, which should not be us, GPs. On the plus side, more access to arrange radiology investigations and other investigations, will help to coordinate an otherwise fragmented care much better than secondary care with all their subspecialties deliver. On the long run it will make Primary Care a lot stronger and should indeed be accompanied with longer training, on par with specialist training.
Henk I think you are agreeing with TC in your explanation. All scans lead to someone having to decide what to do next. I only get a report, not a scan, so it’s not going to be me.
I don’t and won’t refer for CT/MRI for anything given i don’t have access to what’s next. Scans should be done by people who will change management based on result.
That’s not me!
This week followed up a pateint who had been referred to community US, one of these many private suppliers for steroid injection to hip. Had injection to trochanteric bursa plus hip joint; despite US at time of injection saying mild degenerative change and despite the symptoms of the paitent clinically being meralgia paraethetica. UNsuprisingly the injections didn’t help. This is what happens when you try and turf secondary care to GPs. we do as much as we can in primary care with the knowledge we all ahve as indiciduals, all trianed differently, none of us trained as consultants. You bypass our ability to refer when we feel we have got the the edge of our knowledge and you cost more money, patient risks and achieve nothing. It’s total bullshit. I can already refer for whatever scans I want in a timely fashion. It’s pretty linited what I do want. Because I can work out most of what I want from history and examination and beyond that whenI want more inut it’s generally brain power I need.
If the government want early cancer detection come up with new screening processes that are evidenced and then administer them under appropraite guidelines andfunding and workload streams. For patients presenting with non specific symptoms, our area of expertise, leave us to manage it as we see fit and let us refer when we feel we need to. Basically NHSE and govt; you are not clincially trained so fuck off and stop telling us how to clincially manage patients.
@ Finola ONeilll – it’s true. We used to give folk sensible advice and now we have to acquiesce to their requests for distracting scans. Se la Vivre. Maybe best for just Bail-Out?