We recently surveyed GP referrals to secondary care with a differential diagnosis of cancer. We grossed up the number of referrals to annual levels for the whole of Buckinghamshire and compared them to actual annual cancer registration.

The survey was part of the data collection for the New NHS Buckinghamshire Cancer Project, which is using healthcare resource groups and health benefit groups to analyse clinical activity on cancer and how it relates to need.

GPs in three practices were asked to record for three months each patient referred with a possible cancer diagnosis. The practice population is 29,306 and the total registered practice population in the county is 670,830. Cancer registration data was provided by the Oxford Cancer Intelligence Unit.

The differences between actual registration and numbers referred are particularly striking for breast and colorectal cancers (see table), and perhaps reflect levels of 'breast anxiety' and the non-specificity of colorectal cancer presentation. The relatively low number of lung cancer referrals may suggest lower thresholds of awareness among GPs and the public.

If these figures are an indication of actual cancer investigation and diagnosis workload, they have considerable implications for achieving the two-week waiting target to see a specialist for people suspected of having cancer set in a recent circular. The preliminary audit of cancer waiting times which preceded this was retrospective and considered only those who had cancer, not the greater number who were thought to have it.

Dr Shirley Holton Consultant in public health medicine

Buckinghamshire HA

Dr Ken Lloyd Healthcare consultant

Northampton

Dr Christina Kenny

GP

Stony Stratford

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