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Patients to book own chest X-rays under new cancer self-referral pilot

The new cancer self-referral project announced this week by NHS England will run in Mid Cheshire and will allow patients from socially deprived groups with a high risk of lung cancer to book themselves in for a chest X-ray.

According to NHS England, people living in particular areas of Crewe with high incidences of lung cancer and traditionally poor access to health services will be able to ‘self-request’ the tests.

The model of self-referral – enabling people to book their own appointments directly with a diagnostic testing unit or hospital, without first seeing a GP – is one of a range of measures NHS England is testing out as part of a programme of work aimed at diagnosing cancer earlier.

An NHS England spokesperson told Pulse: ‘We currently only have one site in Mid Cheshire which aims to test and evaluate this concept… The current project site is looking at offering a self-request chest X-ray service targeted at specific parts of Crewe where there is a higher incidence of lung cancer and where uptake of health services is traditionally poor. The self-referral concept means patients do not have to present via their GP.’

NHS England said removing the need for people to first see a GP could ‘potentially’ speed up the process of diagnosis, but GP leaders have warned the approach risks undermining GPs’ ‘vital gatekeeping role’.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee said he did not believe the approach would be helpful and warned of over-investigations – but that he was open-minded about the trial.

Dr Green said: ‘Any delay of a few days caused by the need for GP involvement will not turn a patient from treatable to untreatable, and the harms caused by over-investigation are likely to be significant.

‘However, this is only my belief and not proven, so why not have a proper trial, providing the results are subject to scientific and not political interpretation.’

So far the Mid Cheshire is the only site testing self-referral as part of the early diagnosis programme, although NHS England said it may look at starting further self-referral pilots.

The spokesperson added: ‘It is arguably one of the more radical concepts we want to explore and we may well go out to seek further proposals.’

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Readers' comments (18)

  • who will be responsible for reporting and clinically correlating the Xray for the patient?

    I'm going to take a wild stab in the dark and suggest the GP here?

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  • What do the radiologists think surely against guidelines on exposure to radiation?

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  • They're effectively introducing a screening process that ignores all of the acknowledged criteria for such a service to be effective or ethical.
    Does anybody know if there was any public health/epidemiology input into this or is it simply a PR exercise?

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  • I can see how this will go.
    "I want an x Ray, the one for cancer"
    (later) Your chest x Ray is normal.
    "So I don't have cancer?"

    I can't say that. Your chest x Ray is normal.
    "so I could have cancer, then? I want a scan."

    You should see your GP immediately if you're worried.

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  • Vinci Ho

    According to NHS England, people living in particular areas of Crewe with high incidences of lung cancer and traditionally poor access to health services will be able to ‘self-request’ the tests.

    OK , for argument sake, the so called poor access to health services : does that mean there is not enough GPs over there? If so, should NHSE do everything with its might to increase the number of GPs there? Oh!Sorry, I have forgotten its political mission is to close down as many surgeries as possible. Stupid me!

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  • Vinci Ho

    Before one is trying to find some ways to increase suspect cancer referrals , look at national audit office(NAO) 's figures on how many more referrals (justified or not is a separate issue) GPs had made last 5 years . Does it not make bloody sense what you f*c***g need is more GPs? NHSE should shoot itself on the head.

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  • so....if we fill in X ray requests that Radiographers feel are not indicated or do not contain enough detail,they get bounced back.....and now patients can self refer....no clinical info needed then? no examination info??

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  • good, deal with it without a report to the GP demanding "please urgently send 2ww referral to chest unit and let the patient know". IF you start it take the patient through the whole journey and take complete responsibility for it. We can then at least see some patients who actually want to be dealt with properly and not just over investigated.

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  • This has already happened in Leeds with surprisingly positive results. Suspicious xrays are followed up by MDT and CT scans etc arranged by specialists. Generally we as GPs have not seen an increase in work due to this and outcomes in Leeds regarding diagnosing patients at an earlier stage of lung cancer have improved. Lets not always leap to the cynical view that any innovation is negative. Also the radiation dose of a cxr is actually fairly negligible these days. Some people in uk are actually exposed to more background radiation due to radon and also people undertake long haul flights without any consideration of the radiation dose they are being exposed to at high altitudes.

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  • @11.48

    What on earth were you doing being eloquent, logical and SOBER at 11.48pm on a Friday night?

    You are a disgrace to the profession!

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