Breast cancer is among the most common cancer in the UK. During their training period, GPs get limited exposure to breast conditions due to it being a sub-specialist field. However, in the community, GPs are expected to see these patients, identify those with potential cancer and refer them appropriately to a specialty clinic. In recent years, the care provided by general practice has struggled with the expectations of patients, timely access to primary care has deteriorated and referral to secondary care has not been made appropriately for many patients. A significant number of patients with cancer do not have timely referral for specialist care. It has also been shown that 90% of patients referred within the recommended two-week period have non-cancer disease and 50% of the urgent referrals are non-urgent as assessed by specialists. This study will evaluate the performance of primary care in referring patients with breast conditions to specialist breast surgeons so that we can understand if primary care is fulfilling its gatekeeper role and whether it requires redesigning.
The objective of the study is to assess sensitivity and specificity of the referral from the GPs for benign and malignant breast and colorectal conditions and the impact it has on the patient outcome. For both benign and malignant conditions, we will evaluate the proportion of the patients that were urgently or routinely referred to the specialty clinic, the proportion of the patients that were incorrectly referred through the urgent cancer pathway, and the proportion of benign conditions that were first managed in the community before they were referred to the specialty clinic. This is particularly important as previous studies have shown that patients undergo severe stress when referred through the cancer pathway and they continue to be anxious until they are diagnosed with having a benign condition. Moreover, the national guidelines on breast cancer management (2016) recommend onco-plastic treatment for patients with newly diagnosed curative breast cancer. Currently, a significant proportion of breast surgeons are still not trained in onco-plastics. Hence, it will be important to know the proportion of patients with breast cancer who had onco-plastics treatment and whether there are any regional differences.
Number of urgent referrals
Rate of appropriate referrals
Number of routine referrals
Number of patients seen within National time frame for patients with breast cancer
Time taken from referral to treatment
Rate of onco-plastic procedures
Readmission rate following surgical procedure for breast and colorectal conditions
Ahsan Rao - Chief Investigator - Imperial College London
Ahsan Rao - Corresponding Applicant - Imperial College London
Alex Bottle - Collaborator - Imperial College London
Azeem Majeed - Collaborator - Imperial College London
Paul Aylin - Collaborator - Imperial College London
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation