There are other measures under consideration – including introducing ‘self-referral’ for certain diagnostic tests, to a specialist or to attend a diagnostic centre. These may be good ideas, however it’s clear that we don’t currently have the diagnostic centres across the country that we need, or indeed the level of knowledge in patients or in systems in the NHS to make self-referral a pathway that will work for all.
We’re concerned to see the two-week referral target go, and we know many of the women who contact us and who are experiencing symptoms will be worried too. Ruling out cancer at the earliest opportunity and getting the medical help you need is what we all want.
Recent analysis of the latest cancer targets data is very concerning. When it comes to the two week wait target, in June this year, 80.5% of people were seen by a specialist within two weeks of an urgent suspected cancer. The target is 93% and was last met in May 2020. This is for red flag symptoms including abnormal post-menopausal bleeding which a key symptom of womb cancer (the most common the gynae cancers). Swift diagnosis and referral for treatment for cancer makes a huge difference.
Under the new plan, the only target remaining which addresses early diagnosis is diagnosis within 28 days of referral. An analysis of current data shows that in June this year, 73.5% of people were diagnosed, or had cancer ruled out, within 28 days of an urgent referral. The target is 75% and was introduced in 2021. This target has only been met once since then – in February 2023.
The cancer targets may be stripped back to these three:
- diagnosis of cancer within 28 days of referral(after your GP has referred you to a specialist and you see them)
- starting treatment within two months of an urgent referral
- starting treatment within one month after a decision to treat.
Many of the GPs we work with share our concerns. Dr Amir Khan, a GP who works in the north of England, knows just how important being seen quickly can be for patients who are worried about a possible cancer diagnosis: ‘Being seen by a consultant within two weeks of an urgent referral has a huge positive psychological impact on patients for whom this is a highly anxious time. They may get some indication at this stage as to whether their symptoms may be cancer or not. It is also good for GPs to know that our patients will be reviewed soon too and to chase things up if this has not happened.’
Currently there is clear NHS guidance that certain ‘red flag’ symptoms should be referred on the two week wait pathway to be investigated for a potential cancer. This means that GPs know to refer them to a specialist with a target of their first appointment being within two weeks from the patient reporting the symptom to their GP.
Targets which aren’t being attained does not mean that they aren’t the right ones. One of the best, and ultimately most cost-effective ways to improve cancer outcomes is to invest in, and support, early diagnosis. This specific target sent a clear message to doctors and patients that getting a fast answer where cancer’s concerned is important to everyone.
We know the pressures that health services are under and being measured on targets might not always be the most effective way of supporting progress and better outcomes for patients. However, when it comes to the two week wait target, this gives clear guidance to GPs, that key symptoms must be referred and checked without delay.
Muddy that clear message, delay referrals, and we worry that more women with a key gynaecological cancer symptom such as bleeding after the menopause will fall through the cracks, or experience a later diagnosis and poorer prognosis.
Waiting times to see a specialist have grown over the past three years. Wait times for gynae referrals have grown by more than for any other specialism during this period. GP Dr Anne Connolly is worried that the change may increase waiting times for getting symptoms checked, she says: ‘I appreciate that referrals made via the two week wait pathways are increasing and it is clear that specialists are struggling to keep up with the time scales but I don’t believe this change is in the best interest of the patients.
With waiting times to see a specialist getting longer, we are seeing increasing numbers of appointments taken up by patients wanting to know when they are going to be seen by a consultant, anxious because two weeks is already an eternity when waiting for a ‘cancer’ assessment – and they continue to attend with ongoing symptoms needing management. I suspect this change will increase pressure on us in primary care, increase the numbers of patients attending emergency departments and increase inequalities.’
Waiting for a referral and then waiting for tests and then waiting for results is a very worrying time for patients. Being referred under a two week wait with the words from your GP ‘it could be cancer’ is scary for anyone. Facing a late diagnosis and worse outcomes is scarier still.
The early diagnosis of cancer was set as a top priority for the NHS under the last 10 Year Plan. The soon to be published Major Conditions Strategy and the Women’s Health Strategy both put early diagnosis and prevention front and centre. That’s where they should be.
It can take a lot of courage for some people to have their gynae symptoms checked by a doctor. They might not know much about that part of their body and how it works; they might not know the correct terminology, or may have a number of barriers that make talking about it difficult. They possibly won’t know that one of the symptoms that they’re experiencing might mean cancer. Having confidence that you will be listened to and your symptoms will be taken seriously is a huge driver in enabling people to get that early diagnosis which makes all the difference.
We are concerned for these women, that without the knowledge that their symptoms will be taken seriously and investigated swiftly, they may feel it might not be worth checking in the first place. And that it is these women, already facing health inequalities, that will not be in a position to self-refer for tests, further increasing the divide.
We share the view of Dr Amir Khan and many other GPs – let’s keep the two week wait alongside the other cancer targets: ‘I do not see how the two week wait and the four week to test rules cannot run side by side. Often in that initial consultant with a specialist the kind of test required is decided based on individual symptoms, as a one size fits all approach doesn’t work.’
We want to see every single case of cancer diagnosed at the earliest possible opportunity. Keeping the two week wait target, as well as the 28 days to diagnosis or rule out cancer target, should both remain if we all want to do our best for cancer patients. And that’s what targets are there to do – provide a standard to work and demonstrable measure of us doing our best.
Yes, sorting out the ‘bottlenecks’ and delays from diagnosis through to treatment is vital. We must do more and better for patients – the ones in the system today and ones who will be diagnosed in the future, as well as the ones with potential symptoms who need the reassurance of ‘cancer’ being ruled out.
What we have learnt from every other country with consistently improving cancer measures across the whole pathway, is that they have developed and implemented a national and comprehensive cancer strategy. That’s what will make the biggest difference to the most patients – not removing useful targets or allowing patients to ‘self-refer’ to specialists.
You can read more about the news on scrapping the two week wait target at BBC on this link.
You can read more about the self-referral for tests on the Guardian, on this link.