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Gold, incentives and meh

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)

  • Does the Oncology Dept really want queues of worried well at their door, meaning it takes months instead of 2 weeks to get an appointment? If the hospitals don't realise how much dross general practice protects them from then maybe they do need to learn the lesson the hard way.

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  • Hang on... according to the Govt, A&E is overloaded because people go straight to hospital instead of their GP. So it proposes that people should go straight to Oncology instead of their GP, and the logical result of that will be....... Oncology will be overloaded.

    I thought that having an IQ in negative numbers was mathematically impossible, until along came NHS England.

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  • At 9.06

    This could be a patient safety issue. The two week wait could be at risk by overloading the system.

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  • Perhaps I am over-sensitive but this furtther dismissal of GPs as irrelevant at best and obstructive at worst seems to demonstrate the mind-set of NHSE/DoH/whoever came up with this "bright" idea.

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  • Anonymous | GP Partner | 12 January 2015 6:26pm

    Is there anything Maureen Baker does not welcome ? ...

    yes

    1) any talk at looking at alternative models and allowing all GPs a vote on OUR future.

    2) making a fairer exam process.

    3) any moves to help retention and recruitment

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  • As ever there is more behind this than picked up in a press release:
    All projects included came from existing local projects. They are being included in a national evaluation so effective initiatives can be adopted at scale and pace.

    Of the 60 projects only one is about self referral - for chest x-ray (targeted at at risk populations). The vast majority of projects relate providing GPs with direct access to diagnostic tests or putting in place symptomatic pathways/new services for patients with vague symptoms.

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  • so 5:11
    the truth at last? this sounds more plausabe and sensible.
    Pulse being as inflammatory and imaginative with the truth as the Daily Fail on this one.
    The prospect of people just being able to rock up for an MRI of whatever is ridiculous beyond belief.

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  • In some conditions, especially where there are potential delays in presentation and referral associated with poor local outcomes, this can be successful. In Leeds there has been a scheme allowing patients to present for an open access chest xray if they are over 50 and had a cough for 3 weeks or more. As a result of this there was an increase in the number of patients attending for xrays and an association with patients presenting with cancer at a lower stage after the scheme was implemented. I think it is unlikely to be relevant to all cancer types but, if properly targeted and based on local issues with cancer diagnosis and outcomes, then there may be some merit in allowing patients direct access to some diagnostic and assessment services.

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  • Both James Perry and Simon Julme are missing the point. Even if it was 'just' a chest x-ray, it is an investigation involving radiation, and has a cost to it, and with any other investigation, should have a clinical indication for it. the risks/benefits of any investigation are best balanced by an experienced clinician, be it a GP or a specialist, not a patient.

    Even if somone over 50 had a cough for more than 3 weeks, but if they had a CXR 2 months ago which was normal, would you let them do a CXR again?

    And where would you stop? first its CXR, next its MRI, CT, cancer bloods, etc..... You might achieve earlier diagnosis in some cases but would a better route to that not be all ther other suggestions e.g. GP access to diagnostics, more GPs, public education

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  • I already have patients coming to see me 7 days after having hospital tests (ordered by consultant colleagues) and saying, "But the radiographer/ ultrasonographer said my doctor would have my result by now! I don't have an appointment with the hospital for another month and I want to know if they found a cancer NOW!" Patients may well have the scans, but who's going to be left with the responsibility of chasing them up, I wonder. Unfortunately, I really don't see this reducing workload at all. Apart from what everyone else has mentioned regarding resources, risks of over-investigations etc.

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  • Wonderful idea! We could put a scrolling slide for almost every medical symptom known to mankind with a - Headache, Sore throat, abdominal pain, weight gain, weight loss, fever, et al with -- it could be cancer!! Don't delay. Please self refer!!
    Let's see how long the cash strapped NHS lasts in this current paranoid times.

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  • Hey let's transfer cancer referal to a computer algorithm based telephone service like 111. The call handler can run through the algorithm and if the person on the phone fulfils the criteria then they can be seamlessly forwarded to the correct investigation. Simples.

    Look we don't need GPs at all do we. The whole trust of primary care over the last decade has been protocol based - NICE, QOF, 2WW, 'exceptional funding' criteria

    What is this all saying? It's saying that the the managers who organise the service and the 'morons' (personal opinion there PULSE, not statement of fact, please don't censor my opinion) like Prof Thomas who advise them don't believe GPs have any thinking role at all and their input is of no value...except filling in a forms and following protocols.

    This whole period corresponds to a time where primary care crashed and A&E became over whelmed.

    I Wonder why!

    There was a recent fascinating study done in Oxford about the probability of individual jobs being automated and or computerised over the coming years. The use of algorithms etc, as increasingly implemented widely throughout primary care in general, is a prime example. It was interesting to note that they conclude that the jobs least likely to be automated involved complex skills of person to person interaction, mental health and health care. These are exactly the skills involved in primary care. Read the report here
    http://www.oxfordmartin.ox.ac.uk/downloads/academic/The_Future_of_Employment.pdf

    Despite this, the crazy idea persists that 'thought can be removed' from primary diagnosis and replaced by simple tick box rules. i.e. that primary care can be automated away.

    This is what this policy represents.

    Bring it on.

    Good bye Primary Care diagnosis and thought ....hello chaos.

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