GPs in East London have expressed concern that ‘hundreds’ of cancer referrals – including those deemed urgent – are being rejected by their local hospital during the Covid-19 pandemic, against the GPs’ advice.
NHS England had warned in March that some urgent cancer referrals from GPs may need to be downgraded or avoided during the coronavirus emergency, but added that hospitals ‘may not downgrade urgent cancer referrals without the consent of the referring primary care professional’.
But correspondence between GPs in the East London borough of Waltham Forest, seen by Healthcare Leader’s sister publication, Pulse, said ultrasounds and chest x-rays for suspected cancer referrals – some which were sent via the two-week wait pathway – to the Whipps Cross University Hospital were being rejected or deferred.
One GP alone said their practice had 44 referrals rejected from departments within the Barts Health NHS Trust, of which Whipps Cross forms part, between 24 January and 28 April this year, and a local lead GP said 400-500 rejections in total by radiology departments would be a ‘conservative’ estimate – which would include urgent and non-urgent referrals.
In a letter to the GPs, local CCGs said they were ‘taking action’ on their concerns.
However, the CCGs claimed that the referrals were being rejected in line with Royal College of Radiology guidance for clinical prioritisation.
And the hospital trust and NHS Waltham Forest CCG told Pulse that they had identified only two cases where urgent cancer investigation had been delayed in error.
The rejection letter from Whipps Cross hospital to GPs said that ‘imaging referral’ is ‘cancelled due to the Covid-19 pandemic’. It added: ‘Following triage by a consultant radiologist, your imaging request has been assessed as non-urgent and cancelled.
‘If you are concerned that the patient’s clinical symptoms have become more urgent, please re-refer with additional clinical information. Routine referrals should only be re-requested when the coronavirus lockdown is lifted, if still required.’
Dr Sanjoy Kumar, clinical director of the Forest 8 primary care network group, told Pulse that there were approximately 400-500 rejections across all GP practices in Waltham Forest at a conservative estimate.
He said: ‘We are having hundreds of imaging referrals sent back to GPs by Whipps Cross Hospital, Barts Trust.
‘This in itself will result in an increase in all-cause morbidity. Cancer referrals are being sent back to the community for assessment later or if worrying signs develop.
‘GPs only refer patients they need to, and that would be between 4-6% of patients we see – cancer referrals would be less than this number.’
Dr Kumar has approached the local network of CCGs in Waltham Forest and East London regarding the matter, which wrote back that it is ‘taking action as a result of the feedback from GPs to the high number of cancelled diagnostic requests’.
But the letter, received by Dr Kumar last week (12 May), also said that the GP referrals in question had been cancelled ‘following review by a radiologist based on Royal College of Radiology guidance for clinical prioritisation’.
But Dr Kumar told Pulse: ‘What is being preached out there is not being followed by secondary care.’
The reply from the East London CCG group to Dr Kumar said: ‘Firstly we will work with colleagues in Barts Health to outline and communicate the detail behind the cancellations, which were in part a response to the arrangements put in place to manage the Covid-19 pandemic.
‘We are working with Barts to identify the different requirements of patients affected by the cancellations so that we can manage them as appropriate. We will review whether current capacity is sufficient to meet demand, including the possibility of commissioning additional capacity from independent providers.’
It added: ‘We will continue to work with primary care colleagues, the LMC and providers, to establish a timely and sustainable solution that works for them, and most importantly for patients.’
A spokesperson for Barts Health NHS Trust told Pulse: ‘The safety of patients requiring imaging remains a top priority for us during the pandemic and we are working closely with NHS Waltham Forest CCG following feedback from GPs.
‘A review has identified two referrals made under the two-week wait pathway as being delayed. Both of these patients have now been contacted so appropriate clinical action can be taken.
‘During the pandemic, urgent and two-week wait scans will continue to be booked and appointments offered to patients. If GPs consider a scan to be urgent, they can refer the patient with their clinical details and discuss these requests clinically with a radiologist. We would like to apologise to GPs for this extra work created as a result.’
A spokesperson for NHS Waltham Forest CCG said: ‘Following feedback from GPs about the cancellation of a number of diagnostic imaging requests, we have worked closely with colleagues at Barts Health to address the issues raised.
‘Two referrals made under the two-week wait pathway have been identified as being delayed. Both of these patients have now been contacted so appropriate clinical action can be taken.
‘We will continue to work with the trust to identify the clinical requirements of all the routine imaging request cancellations, and any patients still requiring diagnostics will receive them.
‘We apologise to all patients affected. Our priority is to minimise any potential impact on patient care.’
NHS England told GPs last month that they should continue referring as usual to secondary care on the understanding that hospitals ‘accept and hold clinical responsibility for GP referrals’ during the Covid-19 pandemic.
Specialists would be told to advise GPs ‘in a timely fashion’, NHS England added.
But despite this, NHS Mid and South Essex CCGs have told local GPs to continue ‘holding outpatient referrals’.
The Government’s Covid-19 recovery strategy, published a week ago, said: ‘In England there has been a 53% drop in urgent cancer referrals for the week of 27 April and 20% drop in cancer treatments for the week of 20 April’.
NHS England’s restoration of non-Covid services commenced last month, prioritising cancer.