Cancer: GPs urged to directly order scans for vague symptoms

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Ps are being urged to send thousands more people directly for scans in a bid to speed up cancer diagnoses.

NHS England is asking family doctors to order more ultrasounds, brain MRIs and CT scans for vague symptoms that fall outside the current two-week cancer referral to see a specialist.

At present, people with vague symptoms can face long waits for tests or to see hospital medics, and then face delays getting their first treatment.

Under the new guidance, GPs will be able to use their clinical judgment to order more scans for symptoms such as coughs, fatigue and dizziness, skipping the need to see a specialist first.

About one in five cancer cases (67,000) are currently detected after routine testing following referral, meaning people can face unnecessary delays.

By sending patients straight to testing, we can catch and treat more cancers at an earlier stage

According to NHS England, when GPs order these checks directly, waiting times could be cut to as little as four weeks.

Hundreds of thousands of hospital appointments could also be freed up by reducing the need for a specialist consultation first, it said.

Guidance has been in place since 2012 for GPs to have the right to refer patients directly for scans, but NHS England is now pushing on the issue in a bid to get more people diagnosed with cancer in its earliest stages.

The 2012 guidance, Direct Access to Diagnostic Tests for Cancer, said chest X-rays, ultrasound, flexible sigmoidoscopy and brain MRI were “priority areas” to which GPs should have free access.

Now, NHS England is trying to standardise the approach so that regions which may not have access to all the tests can get them.

Its guidance also allows GP teams to use a wider scope of tests in a bid to cut variation across the country.

Quicker diagnosis means less invasive treatments, better recovery and better outcomes

In 2014, an investigation by GP online found local health leaders were preventing GPs from directly ordering the scans.

It found many clinical commissioning groups recommend GPs divert patients through specialist services, with one in 10 putting a blanket refusal on GPs’ direct access to scans.

Some hospitals have shown that when GPs refer directly they can cut waiting times.

In 2018, the Royal Free London NHS Foundation Trust showed that direct access to CT scans for suspected lung cancer meant patients waited an average of 29 days instead of 66 between referral and treatment.

NHS chief executive Amanda Pritchard will tell the NHS Providers conference in Liverpool: “GPs are already referring record numbers of patients for urgent cancer referrals, so much so that the shortfall in people coming forward for cancer checks caused by the pandemic has now been eradicated.

“This new initiative builds on that progress, supporting GPs to provide more opportunities for testing across the country for people who have vague symptoms.

“By sending patients straight to testing, we can catch and treat more cancers at an earlier stage, helping us to deliver on our NHS long term plan’s ambitions to diagnose three-quarters of cancers at stages one or two when they are easier to treat.”

Dr Katharine Halliday, president of the Royal College of Radiologists, said: “For a patient with cancer, every day counts. Quicker diagnosis means less invasive treatments, better recovery and better outcomes.”

Louise Ansari, national director of Healthwatch England, added: “People tell us that when they experience unnerving symptoms they need quicker and easier access to diagnostic tests to either give them reassurance that nothing is wrong or spot problems early so they can have a treatment plan put in place.

“This new initiative will give every GP practice in the country much greater flexibility in what tests and scans they can order for their patients.

“Ultimately, we hope this will help diagnose people who have cancer as early as possible, leading to better quality care and better long-term survival rates.”

From 2023/24, GPs will be able to directly access an even wider set of tests to diagnose conditions unrelated to cancer.

Professor Martin Marshall, chairman of the Royal College of GPs, said GPs are already doing a good job of appropriately referring patients with suspected cancer.

“However, there will be patients who might not meet the criteria for rapid referral and have vague symptoms that could be cancer but are more likely to be less serious common conditions,” he said.

“In these situations, direct access to diagnostic services can be helpful.

“GPs want to ensure timely diagnosis for their patients, so that those with cancer can receive the appropriate treatment, and those without can be reassured.

“This is why the College has long been calling for GPs to have better access to diagnostic testing in the community, and whilst the devil will be in the detail as to how it will work in practice, today’s announcement is a positive step.”

He said that, ultimately, what is needed to improve cancer diagnosis is to increase the workforce across the NHS, including in primary care.

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