Access, workforce, and equity: practice-level predictors of cancer diagnostic activity in English primary care.

Abstract (English)

BACKGROUND: Timely GP referrals are vital for cancer survival, yet diagnostic activity varies due to practice resources and population needs. AIM: We investigate practice-level predictors of diagnostic activity. METHOD: We analysed 2015 to 2023 practice-level data from NHS England/Fingertips and GP workforce statistics for 6221 practices. We estimated fixed effects regressions to explore variability in urgent cancer referrals and conversion rates. Key predictors were ease of phone contact, satisfaction with making an appointment, and GP staffing. We explored differences across quintiles of the Index of Multiple Deprivation (IMD), including it as: 1) additional predictors and 2) fully interacted with predictors. RESULTS: In relation to access, easier phone contact with GP practices was linked to fewer urgent cancer referrals (about -3% of baseline average for a one standard deviation change) but higher conversion rates (+1.3%). We found double-strength associations for satisfaction with appointment making. Regarding staffing, a one SD increase in GP FTE was linked to a 6.6% increase in referrals and a 2% decrease in conversion rates. Similarly, the proportion of female GP FTE at the practice is correlated with more referrals (+3.4%) and lower conversion rates (-2.3%). Practices in more deprived areas had higher urgent referrals but poorer conversion rates. Interacted models revealed that the effect of most predictors diminished as deprivation increased. CONCLUSION: We found a quality/quantity trade-off between patients' experiences of access and practice-level staffing. Targeted interventions to improve access and workforce among practices are essential to reduce inequalities in early cancer diagnosis.