Age, sex and wealth all affect how likely your GP is to refer you for a specialist appointment, a study has concluded.
A UK team analysed data for 130,000 patients, reporting their findings in the British Medical Journal.
Older people were less likely to be referred for three common symptoms, with sex and deprivation also influential.
A charity said the study should raise alarm bells across the NHS.
Michelle Mitchell, Charity Director at Age UK, said: "A doctor's decision to refer patients must be based solely on the patient's clinical need, not their age. Age discrimination in health provision will be unlawful from 2012 and it can't come a moment too soon for older people in need of medical care."
The study from the King's Fund and University College London covered decisions on patients with postmenopausal bleeding, hip pain and heartburn from 326 UK practices across a six-year period.
Once everything else that might influence a doctor's decision to refer - such as smoking, weight, alcohol use and pre-existing conditions - was taken into account, the researchers found significant differences in referral rates between old and young, male and female.
As a guide, the older the patient, the less likely a referral was - in postmenopausal bleeding, someone aged 85 or over was 61% less likely to get a specialist appointment, compared with someone aged 55 to 64.
For patients with hip pain, the difference in referral rates was 32%.
Women were 10% less likely to be referred for hip pain than men, while there was some evidence that coming from a poorer background made a specialist appointment for hip pain and heartburn less likely.
The reasons behind the decisions were not revealed by the study - however, the authors suggested that older patients might be less likely to ask for referral, and that GPs choosing to work in deprived areas might be generally less inclined to refer.
However, they said that the differences could lead to "delays in treatment and poorer outcomes" - and might be an even greater concern if similar patterns emerged in referrals for other common symptoms, some of which could be linked to serious illness.
In an accompanying commentary, Professor Moyez Jiwa, from the Curtin Health Innovation Research Institute in Perth, Australia, said it was hard to know how harmful decisions like this could be.
While some patients might be "denied timely access" to experts, she wrote, others who were referred could be harmed by unnecessary testing and treatment.
She added: "The appropriate referral of cases has economic, quality and safety ramifications that resonate across the health sector and the globe."
She said that database analysis like this could not help researchers understand why GPs and their patients behaved in a certain way in the consulting room.
Older people are less likely to get skin changes checked by a doctor, leading to a steep rise in cancer deaths, say researchers.
The East of England Cancer Registry reports that deaths from melanoma among the over 65s have tripled in the past 30 years.
The elderly are more likely to be diagnosed when the cancer has spread.
Cancer Research UK says pensioners should keep a close eye on moles and report suspicious changes to GPs.
Melanoma is the most dangerous form of skin cancer, and is linked to cumulative sun exposure over a lifetime.
This means that the over-65s are more likely to develop the disease in the first place.
Overlooked
However, unlike younger people, the registry data reveals that the classic signs of a cancerous mole are being overlooked among a host of other changes to older skin.
This means that by the time the mole cannot be ignored, the cancer is likely to be at a more advanced stage, making it far harder to treat.
Dr Jem Rashbass, the director of the East of England Cancer Registry, which collates data on cancer to identify trends among the population, said: "Although there have been some improvements in the number of over 65s being diagnosed with melanoma at a late stage, the figures suggest that more needs to be done to raise awareness about skin cancer among this generally retired population."
Melanoma is a largely preventable disease. Summer may be over, but the damage to skin cells shown by sunburn can remain long after the redness fades"
End QuoteSara HiomCancer Research UK
The registry data revealed that, for every year since 1997, significantly more elderly people have been diagnosed with late-stage melanoma compared with under-65s.
While the death rate among older people rose from four deaths per 100,000 people in 1979 to 11.4 per 100,000 in 2008, the death rate for people aged between 15 and 64 has remained stable.
Sara Hiom, from Cancer Research UK, said: "Melanoma is a largely preventable disease. Summer may be over, but the damage to skin cells shown by sunburn can remain long after the redness fades."
Her colleague Caroline Cerny, from the charity's "Sunsmart" campaign, highlighted the classic warning signs of melanoma.
She said: "If a mole is as big as a pencil-top eraser, bleeds, is sore or itchy, uneven in colour or has jagged edges, then people should visit their GP without delay."
30 November 2010Last updated at 03:55 ETBy Nick TriggleHealth reporter, BBC News
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Andrew Lansley: "If you want to impact positively on people's health you have to look beyond the health service"
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Councils are to be put in charge of encouraging healthier lifestyles under plans to be unveiled by ministers.
Local public health directors will be moved out of the NHS and into local government as part of the shake-up.
The government believes the wider remit of councils in areas such as housing, transport and leisure puts them in a stronger position to tackle smoking, drinking and obesity in England.
A ringfenced pot of NHS money will also be set aside to help.
The protection of the public health budget - the first time this has been done since the 1800s - is considered essential because of the cuts councils are facing following October's Spending Review.
To support local government, the Department of Health's public health white paper will also propose creating a new public health service that will provide advice and support on issues such as health protection, nutrition and treatment.
'Real impact'
A health inclusion unit will be set up as well to oversee the drive to reduce health inequalities, which have widened over the past decade.
Extra money - dubbed health premiums - will be given to the poorest areas to help tackle some of the most entrenched problems.
But details on how the government aims to tackle individual problems, such as obesity, smoking and drinking, will not be spelt out until the new year.
Both the Association of Directors of Public Health and Local Government Association have welcomed the impending changes.
Councils have the potential to make a real difference, but it important public health directors are given the power to influence what is happening"
End QuoteAngela MawleUK Public Health Association
And Health Secretary Andrew Lansley told the BBC the new system would have a "real impact on improving health".
He said: "Health is not just about the quality of healthcare. It's probably at least as much about the quality of people's lives - the environment, the housing, their education and employment."
He said the strategy was intended to improve the health of the nation and reduce health inequalities.
He told the BBC Radio 4 Today programme: "We have got to arrive at a point where politicians stop just telling people how to be healthy but actually help them to do it, which is about positive steps on supporting people on things like physical activity as well as necessary interventions."
The public health White Paper will say the key to encouraging healthier behaviour lies in creating the right environment and then "nudging" people into making different choices.
Examples of this include schemes such as incentivising children to walk to school and providing more support through nurses and health visitors to encourage new mothers to breastfeed.
Employers will also be told they have an important role in helping and supporting staff as well.
Mr Lansley has in the past been critical of what he has said has been the lecturing tone of previous public health drives.
He has also been keen to stress that the solutions do not necessarily require greater regulation.
In fact, the White Paper is expected to make reference to a "responsibility deal" that could be launched in the new year which will see industry sign up to schemes to encourage healthier behaviour.
Angela Mawle, of the UK Public Health Association, which has members in both local government and the NHS, said: "Councils have the potential to make a real difference, but it important public health directors are given the power to influence what is happening.
"I also don't think we should turn our back entirely on regulation. It still has a place."
A gene therapy technique which aims to ease memory problems linked to Alzheimer's Disease has been successfully tested in mice.
US scientists used it to increase levels of a chemical which helps brain cells signal to each other.
This signalling is hindered in Alzheimer's Disease, the journal Nature reported.
The Alzheimer's Research Trust said the study suggested a way to keep nerve cells in the brain communicating,
Ageing populations in many countries around the world mean that Alzheimer's disease and other forms of dementia are set to increase.
Researchers at the Gladstone Institute of Neurological Disease in San Francisco believe that boosting the brain chemical, a neurotransmitter called EphB2, could help reduce or even prevent some of the worst effects of the condition.
Their research suggests that the chemical plays an important role in memory, and is depleted in Alzheimer's patients.
One of the most noticeable features about the brains of Alzheimer's patients is the build-up of "plaques" of a toxic protein called amyloid. Over time this leads to the death of brain cells.
'Thrilled'
However, another characteristic of amyloid is its apparent ability to bind directly to EphB2, reducing the amount available to brain cells, which could in part explain the memory symptoms involved.
This research adds a piece to the Alzheimer's puzzle and provides new leads for researchers"
End QuoteRebecca WoodAlzheimer's Research Trust
To test this idea, they used gene therapy experiments to artificially reduce and increase the amount of available EphB2 in the brains of mice.
When levels of the chemical were reduced, healthy mice developed memory symptoms similar to those seen in mice bred to have a condition similar to Alzheimer's.
Conversely, when the "Alzheimer's" mice were given gene therapy which boosted levels of EphB2, their memory symptoms disappeared.
Dr Lennart Mucke, who led the study, said that his team had been "thrilled" to find this.
"We think that blocking amyloid proteins from binding to EphB2, and enhancing EphB2 levels or functions with drugs might be of benefit in Alzheimer's Disease."
However UK researchers said that the find, while interesting, did not offer a swift answer to Alzheimer's patients.
Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "Our brains are hugely complex and understanding how they work and become damaged by diseases like Alzheimer's is a massive task.
"This research adds a piece to the Alzheimer's puzzle and provides new leads for researchers.
"It suggests a way to keep nerve cells in the brain communicating, which is vital for thinking and memory."
But she added: "We don't know yet if these findings will lead to a new treatment for Alzheimer's - that's some way off."
Report author Roger Taylor says transparency is crucial if problems are to be dealt with
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An analysis of deaths in English hospitals has found 19 NHS trusts have higher rates than would be expected.
But monitoring body Dr Foster's report on 147 trusts shows an improvement on 2009, when the figure was 27.
The survey also shows that four trusts had a higher than expected number of patients who died after surgery.
The NHS Confederation said the report showed where the NHS "could do better". The government says unsafe care will not be tolerated.
However, Patients Association chief executive Katherine Murphy said safety was still "clearly not the top priority" of every NHS organisation.
"We cannot continue with a situation where patients are stuck with poor healthcare because of where they live," she said.
Dr Foster's survey looks at overall death rates and deaths after surgery as well as a range of other indicators to try to build a picture of patient care.
Two trusts - Hull and East Yorkshire Hospitals and University Hospitals Birmingham - had higher than expected overall death rates and rates of deaths after surgery.
A spokesman for Hull and East Yorkshire NHS Trust said its figures reflected that it looks after a population with the highest rates of smoking in the country, along with alcohol problems, obesity and heart disease, and that many of the patents who walk through its doors are already very ill.
Meanwhile, Dr Dave Rosser, executive medical director at University Hospitals Birmingham NHS Foundation Trust, said the report's methodology was flawed. Figures may have been skewed by high numbers of patients with liver disease and could cause unnecessary distress among patients, he added.
The report acknowledges that figures cannot be taken in isolation but should act more like an alarm to point up possible areas of concern.
Roger Taylor, director of research at Dr Foster, said there seemed to have been an overall improvement since last year.
"Safety standards are improving, mortality rates are falling, the variation between the best and the worst is getting less.
Avoidable complications
"However, we do still have a long way to go in terms of involving patients in decisions about their care, enabling them to understand what their options are and ensuring they can always reliably and safely get the best quality care."
Richard Hamblin of the NHS safety regulator the Care Quality Commission says Dr Foster's figures were a useful tool if used properly.
"If a mortality rate is higher than we would expect, or higher than it is elsewhere, we need to start asking why is this?
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Health Secretary Andrew Lansley: "When something goes wrong, hospitals have a duty to report it"
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"Are the patients sicker? Is it that the care is worse? Is it something to do with how the details of the patients are being recorded?"
Of greater concern perhaps are more than 62,000 accidents, mistakes or avoidable complications recorded across all 147 hospital trusts, says BBC health correspondent Dominic Hughes.
The report says many incidents go unrecorded - so the true number may be much higher, he adds.
Nigel Edwards, acting chief executive of the NHS Confederation, which represents the majority of NHS organisations, said: "There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve.
"There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it - this report shows where we can do better."
Health Secretary Andrew Lansley welcomed the report, saying such information was vital to allow patients to make informed choices about care.
But he said: "Unsafe care will not be tolerated. Patients have a right to expect the very best care from the NHS and when something goes wrong, hospitals have a duty to report it and make sure that others can learn from their mistake."
He said the government was taking measures to make the NHS more accountable.
"In future, clinicians will not only be responsible for designing and paying for local health services, they will also be held to account for the quality of care for their patients," he added.
Hospitals with higher-than-expected death rates were:
Barking, Havering and Redbridge University Hospitals NHS Trust
Buckinghamshire Hospitals NHS Trust
City Hospitals Sunderland NHS Foundation Trust
Derby Hospitals NHS Foundation Trust
East Sussex Hospitals NHS Trust
George Eliot Hospital NHS Trust
Hull and East Yorkshire Hospitals NHS Trust
Isle Of Wight NHS PCT
Mid Cheshire Hospitals NHS Foundation Trust
Northampton General Hospital NHS Trust
Pennine Acute Hospitals NHS Trust
Royal Bolton Hospital NHS Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
South London Healthcare NHS Trust
Southport and Ormskirk Hospital NHS Trust
The Dudley Group Of Hospitals NHS Foundation Trust
The Royal Wolverhampton Hospitals NHS Trust
University Hospital Birmingham NHS Foundation Trust
Western Sussex Hospitals NHS Trust
Hospitals with higher-than-expected death rates after surgery were:
Hull and East Yorkshire Hospitals NHS Trust
The Newcastle upon Tyne Hospitals NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospital of North Staffordshire NHS Trust
Taking the temperature outside A&E could give staff an accurate way to predict number of injuries and who will suffer them.
Experts know that extreme weather can affect A&E patient numbers.
Warwick University researchers found that even 5C falls or rises could make a difference to injury rates.
Rates for children were up to 70% higher in summer compared to winter, the Emergency Medicine Journal reported.
Many trusts plan ahead for winter, when the arrival of frost, snow and ice, as well as flu and pneumonia, is traditionally linked to busier shifts.
The study of 60,000 patients found that each 5C drop in minimum temperature during the day meant a three per cent rise in serious accidents to adults.
Heat of summer
The arrival of snow and ice led to an eight per cent rise, as the number of slips, trips and car accidents rose.
However, the study found other increases linked to the heat of the summer, often viewed as a slightly calmer period in emergency departments.
Even among adults, every five degree centigrade rise in maximum temperature during the day, and additional two hours of sunshine, meant a 2% rise in the rate of serious injury.
We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round"
End QuoteProfessor John HeyworthCollege of Emergency Medicine
This effect was particularly noticeable in children, who are more likely to get injured while playing outside during the warmer months.
For them, a 5C rise meant a 10% increase in injury cases, and two hours of extra sunshine boosted cases by six per cent.
While these connections were made by comparing records of hospital admissions with historical weather data, the researchers are convinced that the principle could be used to help emergency teams plan ahead for days when their workload is likely to be higher.
They wrote: "This model could clearly be used to provide predictions of daily admissions, with clear implications for the scheduling of staff and other resources at UK trauma-receiving hospitals.
"The challenge for the future is to improve forecast accuracy further in order to provide sufficient time for the detailed planning and allocation of resources that would be necessary to implement these models."
Professor John Heyworth, president of the College of Emergency Medicine, agreed that the detailed study could help clinical teams know what to expect on any particular day, although he questioned whether the current accuracy of medium-term weather forecasts was good enough to justify staffing changes.
He said: "We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round.
"If you have your emergency department set up to deal with this expected load, then you can deal with extra cases due to weather conditions.
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