POOR professional performance by GPs is an unlikely cause of delays in referral for suspected cancer, researchers have concluded.

The researchers from Durham University, Cambridge University and University College London said such delays largely reflect “limitations in scientific knowledge and in the organisation and delivery of healthcare.”

And in an article published in the British Medical Journal they question government plans to rank general practices according to how promptly patients are referred to specialist services for suspected cancer.

Most patients who have cancer diagnosed after the onset of symptoms are referred after one or two GP consultations (80 per cent), but a substantial minority (20 per cent) have three or more consultations, according to the team.

This number is often considered by policy makers and cancer charities to reflect an avoidable delay.

Professor Greg Rubin, from the school of medicine, pharmacy and health at Durham University, said: “Our analysis shows that different types of cancer may be easy or difficult to diagnose. We recommend a tailored approach to improving services and condemn as misguided the view that performance management of GPs is the key to improvement.”

While multiple GP consultations prolong diagnostic intervals and may affect clinical outcomes and care experience, they largely reflect the diagnostic difficulty of different cancers and the need for initial investigations, argue the authors.

For example, cancers with fairly specific signs and symptoms (such as a breast lump) are easier to suspect and are less associated with multiple consultations than those with non-specific symptoms (such as back or abdominal pain).

They believe that diagnosis may be swifter if there is greater communication between generalists and specialists, and easier access to diagnostics.

But they stress that new diagnostic tests will need to be developed for harder to suspect cancers and be carefully evaluated in trials in primary care.