Abstract / Summary
BackgroundEarly cancer detection is aided by timely GP referrals. However, GP practices face pressures, particularly in deprived areas, which may be associated with diagnostic inequalities.
AimTo examine whether practice-level indicators of access, workforce, and population income deprivation were associated with diagnostic care indicators.
Design and settingRetrospective longitudinal study of 6,194 practices between 2015-2019 and 2022-2023.
MethodPanel fixed-effects regression examined USC referral rates, USC PPV, USC sensitivity, and emergency presentation rates. Predictors were patient-reported access, GP workforce, and practice population income deprivation.
ResultsPer one SD increase within practices, (i) USC referral rates were lower with better appointment-making experience (-1.4%) and older average GP age (-3.5%), and higher with female GP share (+1.3%); GP FTE showed a small positive association (+0.7% to +0.8%). (ii) USC PPV increased with older average GP age (+2.2%). (iii) USC sensitivity was lower with older average GP age (-1.1%); emergency presentations showed limited association with access or workforce factors. Practices had higher emergency presentation rates when serving the most deprived rather than least deprived populations (+13.7%). There was little evidence that deprivation modified access and workforce associations. Average GP age was an exception: USC referral associations weakened from Q2 to Q5, USC PPV peaked at Q3, and USC sensitivity was significant only in the most deprived quintile.
ConclusionPractice-level access and workforce factors were associated mainly with USC referral activity. Persistent deprivation gaps in emergency presentation suggest value in monitoring practice-level USC referrals alongside their PPV and sensitivity, and practice-level burden of emergency presentations.
How this fits inUSC referral rates vary widely between general practices, and previous studies link this variation to GP age, staffing, access, practice size, QOF achievement, and deprivation (1-3). Most evidence is cross-sectional, so it is unclear whether these factors explain stable differences between practices or changes within the same practice over time. We have showed that access and workforce factors were associated mainly with referral volume, while deprivation was more strongly linked to practice-level burden of emergency presentation than to practice-level referral activity. Persistent deprivation gaps in emergency presentations, despite narrowing referral-rate gaps, suggest that equity efforts should look beyond referral volume alone.