This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

A faulty production line

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)

  • Either there is good evidence that a substantial number of cancers are being diagnosed late because of unnecessary delays by GPs (in which case please produce it) or this is non-evidence based and politically driven and those involved are quite happy with the implication that GPs are to blame (in which case stop reading Mr Thomas and the Daily Wail). Alternatively, like the Labour Gvt in 2004, those making the decisions have absolutely no idea how much we do.

    Unsuitable or offensive? Report this comment

  • this is welcome news as ;

    - if simon says it's a good idea then it is.
    - it empowers patients and all patients have legitimate needs and all are vulnerable and all patients will use this resource sensibly. we should stop being cynical and trust our patients.
    - if patients have enough CT scans (e.g. repeated weekly) - then I'm sure they will find a cancer.

    The problem is not politics, poorly thought out ideas, NHSE, CQC, bureaucracy, low morale, retention or recruitment, demand outstripping supply etc. it's cynical GPs - try and be more positive !

    now where are my antidepressants.

    Unsuitable or offensive? Report this comment

  • @1258 or if they have enough ct scans they'll get cancer because of that ;)

    Unsuitable or offensive? Report this comment

  • I agree with this. it will stop a lot of time waster coming to GP's and they can get what they want by wasting someone else time and I can see patients who want medical care and value my advice. Everyone is happy, no complaints. I too have to agree that the gatekeeper role is not what I am here to do. I will not deny patients access to specialists if it is even vaguely clinically indicated or if they are not happy with the advice I give them. If they want a referral because they are worried and want to see a specialist by all mean. Until the NHS constitution takes that right away from them.

    Unsuitable or offensive? Report this comment

  • F*ckwits they might be, but if it takes work away from GPs, and costs of followup tests and appointments, and time for chasing up crap, by all means. let someone else deal with the worried well. Anything to lower our workload.

    My worry here is that looking at the RCGP and GPC response, if this system is put into place, we will have to deal with some of the additional 'fallout' e.g. chase results, follow up appointments, etc. If you want to take it out of the GP's hands, then you better have the resources and manpower to deal with everything after, cos I sure as hell ain't going to be asked to do anything after, if I ever thought a patient did not need to be seen/investigated.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    In a way , this is the mentality of 'patients are exactly the same as customers' as long as you can make it fast and convenient to please them.But customers know what they want when they walk into the shop but patients ? Do they know exactly what they walk into ?
    Of course , we were told to copy Tesco, so let's have a Tesco style of diagnosing cancers!
    By the way, I suppose people realise what has happened to Tesco these days?

    Unsuitable or offensive? Report this comment

  • Aren't we constantly told to involve the patient in decision making over referrals, investigations and treatments, rather than being paternalistic?
    Then NHSE are only taking this advice to the logical conclusion. Better think about re-training.
    Patients with enough money or insurance already can get what they want, levels the playing field for all. Just off to get an MRI for my TATT.

    Unsuitable or offensive? Report this comment

  • Bring it on. Perhaps they will then learn we are of value in deciding who to refer and when.

    Unsuitable or offensive? Report this comment

  • Is it April 1st? This is a joke right?

    Well, when Gibbons writes "Decline and fall of the NHS", we'll know what the final nail was.

    Unsuitable or offensive? Report this comment

  • The Tories have been driving nails in daily,and to their dismay the NHS just wont die.Hopefully it will bite them come election time.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say