'Two week wait' standards for suspected gynaecological malignancy. On target, but missing the point?

OBJECTIVE

To assess the two-week rapid access referral system for UK general practitioners introduced in April 2000 for women suspected of having a gynaecological cancer.

STUDY

DESIGN

An audit of details of women referred between 1st April 2000 and 31st March 2003 via the two-week rapid access system to one gynaecological consultant who performs gynaecological oncology surgery at the John Radcliffe Hospital, Oxford.

MAIN OUTCOME MEASURES: Information on waiting times, clinical indication (postmenopausal bleeding, suspicious pelvic mass, vulval lesions, or "other" symptoms including postcoital vaginal bleeding, suspicious lesions of the cervix or vagina), and subsequent diagnosis were recorded. Data on all other women in whom a diagnosis of a gynaecological malignancy was made during the same period following referral to the same consultant's routine gynaecological outpatient clinic were also collected.

RESULTS

The target time of two weeks to see a consultant was met for 94% of women referred via the rapid access system. The response time declined slightly with increasing numbers of referrals. However, the majority of women with a gynaecological malignancy were not referred via the rapid access system.

CONCLUSIONS

To accommodate the two-week rapid access referrals and achieve UK government targets, there was a reduction in appointments for routine outpatient referrals. However, as the majority of women with gynaecological malignancy presented via traditional referral routes, there is a danger that their diagnoses are being delayed.