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GPs go forth

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.’

Related images

  • Chest X-ray showing pneumonia

Readers' comments (18)

  • Do people on here have to be negative about everything. This sounds like a good idea. Presumably it will be for those smokers who have had a cough for more than 3 weeks rather than just anyone? Cant seer the problem with that. Why should everything come through a GP esp when not enough. Who wants to be a Gatekeeper anyway?Small ammount of radiation so what? Apparently radiologist live longer than other people now because of the small ammount of radiation they are exposed to is beneficial in some way surprisingly. At least that what one of them told me the evidence suggested so I guess we shouldnt worry about the odd CXR.

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  • I asked for a CT scan on a patient who was losing weight, unable to swallow and had been on fluids for 18 days. He had been cleared by 2ww upper GI; the only finding I had in hand was a palpable supraclavicular lymph node so I asked for a CXR. This was normal. I persisted with a request for CT Chest and abdo but recd a letter from Radiology declining and suggesting I contact a hosp Physician as do not accept CT referrals from GP. A few days later the hosp Consultant wrote to all GPs expressing concern regarding unwarranted urgent referrals - I wonder whether this was related.
    Suffice to say nothing was done. I re-refd the patient to 2ww upper GI for a reviiw - Pt now diagnosed with Oesophageal Tu with metas and still waiting for treatment after 4 months.
    The point is:
    1. A hosp doctor can request CT/MRI if concerns but is a GP so studpid that he has no right to request one. The arrogant and fallacious approach of Trusts and Consultants needs to change. I find it hard to believe that we are still regarded as a second rate profession by Consultants - with due respect to the knowledgeable and pragmatic ones- who can't see anything further than their speciality of chest, bones or whatever.
    Is it economically sensible to refer to a rheumatologist for an anti-CCP antibody test just because you are not allowed to request one because 'you are just a GP'?
    I think, if that is the approach to general practice, NHSE might as well allow all patients to self-refer to 'Specialists'.
    Brings to mind an incident where a young lady with persisting lower abdo pain went through a hysterectomy due to 'endometriosis' but the pain did not settle. She then went on to have an MRI if was revealed that she had a spine bifida that needed attention.
    Another where the patient was treated for years by a 'Specialist' with fibromyalgia while the cause was Addison's disease and diagnosis made later in primary care by the 'stupid' GP.

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  • Anon GP 11.48 describes how well the system is working in Leeds: I suppose it is too much to hope that the 'pilot' in Crewe will learn from the established Leeds set-up?

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  • Hi Snjeev,
    I have stories on which I can write a book. Countless times, I have called and asked the Registrar or the specialist to revisit the diagnosis

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  • same will be when for example they come for something else like a flu jab, "whilst im here, I want a blood test for cancer" what test? "you know the test for cancer" , I know why not do an online shopping for investigations- tick the box, put it in the basket, after all it wont cost anything, might be a good idea if the prices of these test were shown and a disclaimer to state that no test in the world is 100% reliable , so I think the government is trying to get rid of primary care

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  • How much more waste of money is NHS is going to inflict on Britain.Was it not enough to force cheap sulphonyureas and cost more than one hundred times more in cost of treatment of Hypoglycemia in secondary care .Tide effects which caused MIs,CVAsRenal failures,strokes and amputation and high cost of incidence rising.NICE had clearly stated if you fear hypoglycaemia do not prescribe Suplphonylureas.Endocrinologist including Profesors have said it frequentlyoccured with them.
    Any person who fancies an Xray whether it has been medically disgnosed as necessary can sask for it.GPs will lose the gatekeeping function,with tremendous load on secondary care.Radiation from xrays can be cumulative and cause cancers.Has this been given a thought?
    It is time NHSD should report to a higher authorirty,just as GMC which tends to play bal with National Health

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  • Let's irradiate people then give them cancer, great plan. Lets just keep of smoking advertising legislation to make a resson to have cancer first! High risk - can you imagine the argument when all these yummy mummies want an xray because heat magazine said drinking water can give you lung cancer?

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  • Ill defined lesion, patchy area, poor penetration...have another xray, go on have a ct, nah bronch. All normal, but you might get cancer still.

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