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Patients to be allowed to self-refer for cancer diagnostics without going through GP

Patients will be able to self-refer themselves for cancer diagnostics without needing to go through GPs as part of NHS England’s new strategy for tackling cancer, which GP leaders said could ‘undermine GPs’ gatekeeper role’.  

As part of NHS England’s early diagnosis programme announced over the weekend, it will pilot initiatives to offer patients the option to self-refer for diagnostic tests, lower referral thresholds for GPs and introduce multi-disciplinary diagnostic centres where patients can have several tests in the same place on the same day.

It will also set up a taskforce to develop a five-year action plan for cancer services based on the pilots that will include representatives from the RCGP, as well as Macmillan Cancer Support, Public Health England and local councils.

The initiatives will be piloted across more than 60 sites around the country, and they could be implemented from 2016/17, NHS England said.

This comes as NICE published draft guidelines that lowered the risk threshold for which potential cancer symptoms should be referred to diagnostic centres and specialists.

Pulse has already reported that GPs are having urgent cancer referrals bounced back by secondary care, and GP leaders warned that this move could increase the pressure on diagnostics centres, as well as undermining GPs’ role as gatekeeper.

NHS chief executive Simon Stevens said that NHS England’s plans could save 8,000 lives a year.

He said: ‘Cancer survival rates in England are at an all-time high, but too many patients are still being diagnosed late – up to one in four only when they present in A&E.

‘So it’s time for a fresh look at how we can do even better – with more focus on prevention, earlier diagnosis and modern radiotherapy and other services so that over the next five years we can save at least 8,000 more lives a year.

But Dr Kailash Chaand, deputy chair of the BMA and a retired GP in Lancashire, warned that this could undermine GPs’ role as gatekeepers.

He said: ‘There are two issues in this. Fiirstly, who is going to benefit from this? If it benefits patient outcomes, then that is good. But anyone who has a headache for three days might think it is a brain tumour. Overall the whole appointments systems for diagnostics will get messed up. The total outcomes will be limited.

‘Secondly, for the past 10-15 years, the GP role as a gatekeeper has been undermined, with the likes of walk-in centres. This is now going full steam. I won’t be surprised if politicians start saying we don’t need GPs.’

Dr Maureen Baker, chair of the RCGP, said that she welcomed the move, but said the college will look at the proposals to self-refer.

She said: ‘An average GP might see eight new cases of cancer for every 8,000 patient consultations and 75% of referrals made after just one or two GP consultations lead to a positive diagnosis.

‘However, there is always more that can be done and the early diagnosis programme to improve cancer outcomes, is particularly welcome – as is the proposal to create diagnostic centres that could do multiple tests in a single day.

‘We are prepared to look at all the proposals, but in the case of self-referral we would need to understand how it could work effectively without diverting resources from other services.’

Related images

  • ultrasound scan cancer diagnostics PPL

Readers' comments (52)

  • How long before the system collapses?can secondary care cope with a flood of worried well?can we afford it.Once diagnosed how long for a op with no slack in the system.Before the idiots bring up an idea like this they should see if its doable in the first place.My money is on a complete mess like the cancer drugs fund.

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  • People are already saying we don't need GPs.

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  • Giving GP's access to MRI /CT is the obvious solution . Open access to all will be an expensive mistake limiting use for those who actually need it .

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  • Await the flood from Dr Google

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  • What a bunch of F~#kwits . All medical investigations carry a risk - especially those involving radiation . CT is an X-ray density map . Do enough and these might induce cancer in falsely reassured people . Targeted investigation is better all round. Can I suggest mantle irradiation of 2000 rads for berks that thought this one up

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  • The current NHS system cannot cope with this demand and this will be the ideal opportunity for private screening companies to come in and offer these tests to all and sundry. Privatisation of services which will have to be open to tender, removal of these pesky, difficult GPs who get in the way of patients having all these lovely tests and collapse of the NHS hospitals who will have to actually manage and further investigate these patients who may be falsely negative plus as an added bonus the failure of all CCGs budgets paying for all these excessive tests and investigations. Sounds like a brilliant strategy to make the entire NHS system fail to me....

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  • Fechiniijits

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  • Very good if it helps speed cancer diagnosis but it is yet another tier and might just be another sticking plaster on a flawed system. It will also require additional funding to prevent delays and withdrawal of other services? However at present patients often fall in between the precise referral criteria yet GP clinical judgment dictates that cancer needs to be urgently excluded. These patients still frequently turn out to have cancer but often face severe difficulties and delays negotiating the system especially in areas that have referral (mis)management. The GP will still need to be involved and somehow get them investigated and fight against their urgent cancer referrals that are bounced back by referral management and secondary care.

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  • It's not as if every patient with a headache thinks they have a brain tumour or those with a cough think they have lung cancer or anyone with a rash or an itch thinks they have skin cancer. I'm sure the system will cope!!!!!

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  • Well at least it may permit some of our consultant colleagues to move their personal thinking on from:-
    "stupid GP's refer too many people who don't have cancer"
    to
    " there are a large number of people very worried and presenting symptoms suggestive of, but who do not have cancer."
    The only absolute in my book is that the direct access service must manage the repeated attendances for rechecking and not deflect them onto the GP, given the published body of evidence that
    "reassurance investigation"
    increases frequency of future presentation.

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  • No it's probably just 10 % - cope with that ! HA HA HA .

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  • Peter Swinyard

    No, in my personal capacity as a GP, I do not support this initiative. It is at best well-meaning but muddle-headed.
    One of the basic tenets of making a diagnosis is to start with the history and no computer algorithm, or NHS111, or Dr Google, is as good as a GP listening to the patient, asking the right questions and formulating a management plan. As a previous respondent said, investigations themselves carry a risk - which is why X-rays must legally be signed off by a practicing doctor.
    The positive return on investigations requested by GPs is already much higher than those requested by hospital junior doctors - we all worked there once but have added years of experience and training since.
    This is populist nonsense in an election year. I am not being protectionist over our craft - but I am being protectionist over our patients' welfare and our NHS resources.

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  • why are people fretting about being 'needed'.

    Do you think anyone at NHSE has done a cost benefit analysis on this? do you think they know how to open a spreadsheet?

    Its uncosted and based on unproven associations with 'increased cancer diagnosis rates ' in some parts of Europe.

    As usual NHSE is full of zombies with single digit IQ's - what do you expect?
    Can you imagine the number of incidentalomas that will be picked up and have to have some sort of treatment!

    I suspect we'll be even busier then ever(unfortunately).

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  • Clearly idiotic, but a logical step when patients already have a right to further referral and investigation under the NHS constitution. More annoying is the frequency with which it takes us 3-4 referrals into secondary care to get a specialist to take vague symptoms seriously, and investigate sufficiently to find the cancer we suspected due to professional experience & gut feeling, but couldn't irrefutably find on a diagnostic test.
    The resourcing of this will be near impossible.

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  • To Dr.Chaand,
    I will be very glad if that happens. We are trained to be doctors, not advocates and gatekeepers. We need to move on from this old ideology
    In any case, I do not count myself as a gate keeper.

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  • I think investigation facilities should be made available to all patients who are worried about cancer and should be able to self refer for cancer investigations - but such patients should be charged for these investigations.

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  • The guidelines on GP direct access are a welcome addition - at least there is some sense.

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  • send everyone for everything- or go to court to defend your criminal negligence; stable is on fire, doors have been removed, why are you trying to keep the horses inside?

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  • Absolute tosh!

    My partner is a specialist nurse and runs triage for cancer referral in her speciality - I hear almost daily moaning of GPs referring Pt who really should not be referred. Anything from one episode of rectal bleed with no other symptoms (yes, they can be referred under normal pathways but shouldn't be under 2ww) to someone who already had investigation just 6/12 ago with no change in symptoms (and no mention of having these done in the referral, suggestive of improper considerations).

    Many of us are very good but some of us are not. And the public will be even less medically trained then not so good GP......

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  • I am imagining a process whereby 2ww referral forms are available for the general public - and if they can tick one of the boxes, then can then go for the special cancer tests.

    If it is done properly (agree that is unlikely with NHSE) it might actually help. It will stop 15 year olds insisting that they need cancer referrals for their 4 days of diarrhoea and might stop cases where the press blamed the GP for not referring early in unusual cases. (Like Stephen Sutton)

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