Public patients ‘lack direct access to cancer tests’

More than 90% of GPs can refer patients with suspected cancers directly for diagnostic tests if those patients can pay privately, but the proportion slumps to just 10% of some cancers if the patients have to go on public waiting lists.

Direct access to diagnostics for all patients is number one on GPs’ wish-lists says the Irish Cancer Society/Irish College of General Practitioners report.

Access to 11 diagnostic tests was examined and the rates did not fall below 89% for private patients.

However, when the same tests were sought for public patients, GPs’ powers were limited and they had to refer their patients to consultants, outpatient departments and other services first before a decision was made whether to order the tests which greatly increased waiting times.

Around 46% of the population have private health insurance while 39% have medical cards. The remainder has neither.

Chest X-ray was the only test for which there was no difference with 99% of GPs saying they could send patients directly without going through a third party regardless of whether they were private or public. Private patients got their X-ray in one working day on average while the average for public patients was two days.

When it came to CT and MRI scans, however, the difference was vast. While 89% to 91% of GPs could send private patients directly for these tests, 16% to 24% of the same GPs had that option for their public patients.

An abdominal CT scan for a private patient took on average six working days compared to an average of 55 for a public patient.

The study surveyed 592 GPs in 214 practices with an average of just under 4,000 patients per practice. About half the practices had a minimum of 50% public patients.

Claire Collins, director of research at the society, said factors such as the rural or urban location of the practices, their distance from hospitals and the wealth or poverty in the environment in which they worked were all taken into consideration but none had as much influence on patient experiences as to whether they were private or public.

Dr Collins said the rapid access clinics set up in the past 10 years for breast, lung, prostrate, and melanoma cancers had made a big difference in speeding up tests for all patients.

“The feedback from GPs in relation to those clinics is extremely positive and we would support more rapid access clinics for other cancer areas,” she said.

Donal Buggy of the Irish Cancer Society said: “Early diagnosis often means a cancer is more likely to be treated successfully, an intervention will be less complicated and chances of survival will be higher.

“This research makes abundantly clear that doctors working across all socioeconomic areas face a struggle in securing timely tests to provide diagnoses for public patients.”

Mr Buggy said the fear that GPs would order unnecessary tests if they had direct access for public patients was not borne out by the experience in other countries with one UK study showing only 12% of extra tests ordered were found to be unwarranted. The only disadvantage found for people with private health insurance was they were more likely to delay visiting their GP than medical card holders in the first place.