Cancer - A life or death referral lottery

23 August 2012

The Department of Health says that 250,000 people are diagnosed with cancer in England, every year. To put this figure into perspective: 250,000 people would fill the Olympic stadium in Stratford more than 3 times over. 130,000 of these people will sadly die within the year. 

This figure is made all the more shocking when compared to other European countries. Despite spending twice as much per head on cancer as countries such as Spain and Portugal (around £6 billion ) we still ranked below them with one of the lowest survival rates for the disease in Europe in 2009.  Cancer Research UK says that if survival rates in Britain matched the European average, between 6,000 to 7,000 fewer people would die every year.  We need to ask what is going wrong and why has this not been rectified.

The National Cancer Intelligence Unit has found one explanation. In its analysis of more than one million patients, it found a threefold variation in how often GP’s referred patients to cancer specialists.  Factors that influence a GP’s decision to refer include:

  • Age: 16 to 24 year olds were twice as likely to require at least three visits before a referral than those over the age of 65;
  • Gender: men were generally referred after fewer visits than women, save for certain types of cancers;
  • Ethnicity: ethnic minority patients were less likely to be referred than white patients; 
  • Cancer type: patients suffering from a particular type of cancer more common in a GP’s catchment area were more likely to be referred; and 
  • Patient’s affluence: more wealthy patients would insist on referrals.

We should not underestimate the difficulty for GP’s in making a correct referral because the signs of cancer are often very subtle. A recent BBC News article  quoted Jessica Harris, health information manager at Cancer Research UK, who explained:

‘A GP will see only around eight cases of cancer a year, on average, among hundreds of people with symptoms that might indicate cancer, so making appropriate referral decisions can be challenging, especially for rarer cancers or those with symptoms that are vague or common to other diseases.’

It is still a worrying statistic that in general, a quarter of all patients needed to visit their GP at least three times before being sent to a specialist.  The general consensus is that an early diagnosis followed by prompt treatment gives a patient the best chance of survival. If this window of opportunity is lost, the results can be life threatening.

Clinical negligence claims in this area focus on the effect of a delayed diagnosis on a patient’s prognosis. A number of factors will influence the assessment of a claim, including:

  • the type of cancer;
  • the rate at which the type of cancer progresses and/or spreads;
  • the patient’s underlying health; and
  • the period and extent of delay in referral and treatment. 

Clinical negligence claims against GPs for failure to refer are on the increase. The General Medical Council gets more complaints against GPs than any other branch of medicine. Of these complaints, 15% related to a failure to correctly refer a patient . National cancer director, Professor Sir Mike Richards recently stated that ‘…GPs should consider their referral practices, which will help to drive up standards of care for everyone.'  Looking to the future, he added:

‘…we are investing over £450 million to achieve early diagnosis, which will support GPs to assess and diagnose cancer better, and pay for additional testing and treatment costs’.

If you would like advice regarding a delayed diagnosis of cancer,  please contact the Clinical Negligence and Personal Injury team on 020 7814 1200 or by email at


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