Introduction:This paper reports on an ongoing primary care audit of cancer referrals undertaken in Scotland in 2006–2007 and 2007–2008.Methods:General practitioners (GPs) in Scotland were asked to review all new cancer diagnoses within their practice during the preceding year.Results:4181 patients were identified in year 1 and 12 294 in year 2. The pathway taken for patients to present to, and be referred from, their GP has been analysed for 7430 of the 12 294 patients identified within year 2 across five separate health boards. The time from first symptoms to presentation to a GP varied between tumour types, being the longest (median 30 days) for head and neck cancers and the shortest (median 2 days) for bladder cancer. In all, 25% of patients within the following tumour groups waited longer than 2 months to present to their GP following first symptoms: prostate, colorectal, melanoma and head and neck cancers. Once patients had presented to their GP, those with prostate and lung cancer were referred later (median time 11 days) than those with breast cancer (median time 2 days). The priority with which GPs referred patients varied considerably between tumour groups (breast cancer 77.5% ‘urgent' compared with prostate cancer 44.7% ‘urgent'). In one health board the proportion of cancer patients being referred urgently increased from 46% to 58% between the first and second audit.Conclusion:Our data show that there are very different patterns of presentation and referral for patients with cancer, with some tumour groups being more likely to be associated with a delayed diagnosis than others.

An Excel spreadsheet template with defined parameters and preset drop-down options was provided to participating practices, with instructions on its use. The template was locked to prevent changes being made to it. The parameters requested were: age at referral, sex, and specific cancer suspected (bladder, brain, breast, cervical, colorectal, endometrial, gallbladder, laryngeal, leukaemia, liver, lung, lymphoma, melanoma, mesothelioma, myeloma, oesophageal, oropharyngeal, ovarian, pancreatic, prostate, renal, sarcoma, small intestine, stomach, testicular, thyroid, vulval, other AimTo examine primary care referral patterns, compliance with referral guidance, and eventual outcome for patients. Design and settingProspective audit within general practice in Scotland. MethodGPs in Scotland reviewed all urgent suspected cancer referrals over a 6-month period. They noted the final diagnosis and assessed whether the referral was in accordance with agreed referral guidelines. ResultsA total of 18 775 urgent suspected cancer referrals were analysed from 516 GP practices. The referral rate ranged from 3.7 to 24.0 per 1000 per annum; 30.8% of referrals were for patients aged under 50 years, yet this age group accounts for only 11.1% of all diagnosed cancers; 10.3% of all urgent cancer referrals were for suspected melanoma, despite this cancer accounting for only 4.1% of new cancers. The proportion of patients subsequently diagnosed with cancer was greatest for leukaemia (61.7%), prostate (52.6%), and lung cancer referrals (39.7%), and lowest for melanoma (11.8%), oesophago-gastric (11.2%), brain (10.6%), and laryngeal cancer referrals (7.8%). Compliance with referral guidelines was 90.9%. A large proportion of referrals considered to be outside the guidelines still had a cancer diagnosed (urological 15.9%, lung 8.8%, colorectal 8.4%, and breast 6.4%). ConclusionThere is wide variation in GP referral rates for suspected cancer with a greater than expected proportion of referrals for younger people. Many referrals considered to be outside the national guidelines were diagnosed with cancer, suggesting factors other than those in referral guidelines alert GPs to the possibility of cancer.

Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.

Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.

BackgroundElectronic care coordination systems, known as the Key Information Summary (KIS) in Scotland, enable the creation of shared electronic records available across healthcare settings. A KIS provides clinicians with essential information to guide decision making for people likely to need emergency or out-of-hours care.AimTo estimate the proportion of people with an advanced progressive illness with a KIS by the time of death, to examine when planning information is documented, and suggest improvements for electronic care coordination systems.Design and settingThis was a mixed-methods study involving 18 diverse general practices in Scotland.MethodRetrospective review of medical records of patients who died in 2017, and semi-structured interviews with healthcare professionals were conducted.ResultsData on 1304 decedents were collected. Of those with an advanced progressive illness (79%, n = 1034), 69% (n = 712) had a KIS. These were started a median of 45 weeks before death. People with cancer were most likely to have a KIS (80%, n = 288), and those with organ failure least likely (47%, n = 125). Overall, 68% (n = 482) of KIS included resuscitation status and 55% (n = 390) preferred place of care. People with a KIS were more likely to die in the community compared to those without one (61% versus 30%). Most KIS were considered useful/highly useful. Up-to-date free-text information within the KIS was valued highly.ConclusionIn Scotland, most people with an advanced progressive illness have an electronic care coordination record by the time of death. This is an achievement. To improve further, better informal carer information, regular updating, and a focus on generating a KIS for people with organ failure is warranted.