Researchers say GPs in England, Wales and Northern Ireland less likely than other countries to refer possible cancer patients immediately

Delays in testing for cancer at GPs’ surgeries may be the reason why patients in the UK are more likely to die of the disease than those in comparable countries, according to authoritative new research.

Cancer patients in the UK have a lower chance of survival than in Australia, Canada, Norway and Sweden – four of the five countries that have been compared with the UK in a series of investigations over the past six years. Only in Denmark, the fifth country, are the survival rates as low as in the UK.

Research by the International Cancer Benchmarking Partnership, launched by the then cancer tsar Sir Mike Richards in 2009, has shown that cancers in the UK tend to be more advanced when patients are first treated. But until now, the reasons why have been uncertain.

The latest paper, published in the journal BMJ Open, finds that there are delays in the GP surgery. GPs in England, Wales and Northern Ireland are less likely than in other countries to refer people with possible cancer immediately for tests or to a specialist.

“Probably three to four years ago, we wondered whether it was Anglo Saxon reserve or British fatalism and things like that,” said Richard Roope, of the Royal College of GPs who is Cancer Research UK’s clinical lead for cancer. “It isn’t. It looks as though GPs are becoming the most significant factor. It is partly our system but also access to diagnostics.”

GPs in the UK do not have easy access to MRI and CT scans. If they refer a patient to hospital for the tests, there may be a long wait for the scans and another wait for the results. Of all the six countries, the UK has the lowest spending per head on health, said Roope. But the system may also be a problem, he said. GPs in the UK will do blood tests and wait for the results before they decide to seek a scan. In Sweden and Australia, all the diagnostic tests are done at the same time.

There are now changes underway to improve the access GPs have to diagnostic tests, but it is a complex business, said Roope. Breast cancer is the easy one. A woman who turns up with a lump will be referred immediately to a specialist. In some cancers, the symptoms, such as stomach pains, are far less clear.

And in other countries, GPs can more easily get advice from specialists when they think a patient may have cancer. “I have been a GP for 24 years,” said Roope. “If you turn the clock back 20 years there was probably better communication between GPs and consultants.” Management structures in hospitals came between them and many of the weekly educational meetings that used to be held have since ceased.

The benchmarking study was based on survey responses from 2,795 GPs on how they would manage different scenarios of patients coming to them with possible cases of either lung, colorectal or ovarian cancer. These were then mapped against survival data for those countries.

GPs were then asked a series of questions including what access they had to specific tests, waiting times for tests and results, and whether they could speak to cancer specialists for advice.

More than 70% of GPs in England, Wales and Northern Ireland reported direct access to blood tests, x-rays and ultrasound for possible cancer diagnosis – similar to the rest of the countries. Australian GPs in Victoria reported the highest access to all these tests – about 99%.

But only about one in five GPs in England reported having direct access to CT and MRI scans while their peers in all other countries reported having at least twice the level of direct access to these tests. GPs from across England, Wales and Northern Ireland also reported some of the longest waiting times for the results of CT, MRI and ultrasound scans.

Northern Ireland had the longest waiting times for tests and results of ultrasound and CT scans – seven to eight weeks. England’s average waiting time was nearly five weeks and Wales was around seven weeks for both types of scan. New South Wales in Australia did best, with a total waiting time of around 1.5 weeks.

“GPs have a difficult job to do,” said Sara Hiom of Cancer Research UK, which funded the study. “They have to ensure those who need specialist tests get them, without overloading a health system that’s already strained. But their role as gatekeepers to further investigation and specialist care does need to be reviewed in the current context.” CRUK is working with GPs to improve early diagnosis, she said.