Since the November issue of the Annals, the following letters have been published on our website <http://www.rcseng.ac.uk/publications/eletters/>:
letter . 2006 Jan;88(1):26. doi: 10.1308/003588406X83096
letter Ann R Coll Surg Engl. 2006 Jan;88(1):26. doi: 10.1308/003588406X83096
The authors state that 700 referrals per year should be received for a population of 200,000. However, only 64 patients were included. With a catchment population of 270,000,1 the number of referrals should be 1,732 over 22 months.
In addition, the investigations included an ultrasound or an intravenous urogram. We feel that omitting the former in some patients may risk missing renal parenchymal pathology.
No mention is made of patients over 50 years with microscopic haematuria. In our experience their referral pattern is just as haphazard. We are impressed that the extra wait for letter referral is only 2.5 weeks. Unfortunately, other centres such as ours are less fortunate, even though we evaluate 20–30 patients every week. Attempts to increase capacity have been unsuccessful, mainly because of workforce issues in other departments (eg radiology). As a result there are cases of advanced bladder cancers referred by letter that have waited up to three months.
In the past all referrals were prioritised by a consultant surgeon. With the implementation of the two-week rule, clinicians have lost control of the appointment system. In our opinion this is another example of how political interference, no matter how well meant, can adversely affect patient care.
Reference
- 1. http://www.wessex.org.uk/medical/trusts/trustnhh.htm [cited 23 November 2005]