Identifying and managing patients at low risk of bowel cancer in general practice

All NHS patients who are suspected to have bowel cancer by their general practitioner should now be seen by a specialist within two weeks. The government introduced this policy in July 2000 in response to concerns that some patients had to wait too long for an outpatient appointment. However, this new policy could distort referral patterns either by increasing the referral of patients with transient symptoms or by increasing the delay for cancer patients presenting with non-typical symptoms. Unless general practitioners act as efficient gatekeepers, specialist services could become overloaded. We explain the basis for the government's guidelines for referral and discuss how to manage patients at low risk of cancer.