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NHSE: GP practices may have to provide extra tests when referring cancer patients

GPs may be asked by hospitals to carry out additional tests when referring patients with suspected or confirmed cancer to help prioritise cases, NHS England has said.

In its Covid-19 standard operating procedure for general practice, updated yesterday, NHS England released new details on how GPs should deal with patients with suspected or diagnosed cancer, including those having ongoing treatment.

In addition to carrying out tests 'if they have appropriate access', GPs should be prepared to 'implement effective safety netting' for people presenting with symptoms, said NHS England.

But the BMA said that while both primary and secondary care clinicians have been under 'immense pressure' during the outbreak, it was crucial that new ways of working 'do not place unrealistic expectations on anyone'.

The NHS England document said practices should continue to refer patients under NICE guidance.

It said: 'Secondary care will triage and prioritise if capacity constrained. Practices may be asked to support prioritisation with additional tests alongside referrals, if they have appropriate access.

'Practices should ensure they implement effective safety netting for people presenting with symptoms.'

The guidance added: 'Post-referral, secondary care will use patient tracking lists where investigations take place at a later date. Clear processes for clinical assessment if there is any change/deterioration in a patient’s condition are vital.'

It noted that it still remained the case that secondary care would require consent from the referring clinician in primary care before any urgent cancer referrals are downgraded.

The guidance also noted that patients who are due to begin or are undergoing cancer treatment will consider with their oncologist whether to start or continue this during the pandemic.

'Some patients may wish to defer referral/treatment – if practices are unable to follow usual practice, they should ensure decisions and reasons are recorded and safety netting in place,' added NHS England.

In response BMA GP Committee chair Dr Richard Vautrey said GPs must be 'properly resourced' when required to carry out any new activities.

He said: 'Clinicians across the NHS, in general practice, hospital and other services have all been under immense pressure in the past months responding to the Covid-19 pandemic.

'It is vital that they work together to develop improved, sustainable care pathways that do not place unrealistic expectations on anyone.'

He said: ‘Due to the reduced number of patients attending hospitals, GP practices are being expected to undertake tests and prescribe medication for hospital patients that would normally be given in secondary care.

'This includes undertaking work, including at times the completion of tests, before making a possible cancer referral to prevent delays in treatment.'

Dr Vautrey added: 'General practice must be properly resourced for any new activity in order that staff can continue to give patients... the safe, high-quality care they need and deserve.’

Earlier on in the pandemic, London GPs were blocked from referring patients with urgent suspected bowel cancer to hospitals based on symptoms alone, under changes to local NHS guidance brought about by the Covid-19 outbreak.

NHS England’s London team raised the two-week wait referral threshold for lower gastrointestinal cancer and said that patients could only be referred if they had a positive FIT test result.

But GP cancer experts warned a negative FIT test result, which contradicted NICE guidance, does not rule out cancer altogether.

The team later declared that it had explained to GPs that they may refer patients if there is ‘strong clinical suspicion’, but that a FIT test must still be carried out to aid diagnoses.

Readers' comments (21)

  • And why can’t secondary care organise the FIT test if it’s that big a deal to them?

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  • National Hopeless Service

    GPs do GP stuff. We are under no contractual obligation to employ nurses/phlebotomist. I can understand the need to change how we do things but if the NHS wants more tests in the community they must fund extra community services.

    My staff, colleagues and I are at full capacity and struggling

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  • Their debts are wiped. Primary care is getting shafted by Kanani and Waller. It is a scandal. You'll soon be doing anoscopy, dermatscoping and slit lamping. Modern slavery.

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  • Here’s a wild idea; if secondary care want Pre-investigations undertaking before accepting a 2WW that’s pretty much against a lot of NG-12 so inkling of a research project?

    Not seen any published work on high-risk patients
    and FIT test and certainly a -ve FIT doesn’t exclude cancer just helps decide investigation options (Nottingham used this to help decide colonoscopy or CT)

    Suggest use Covid-19 extra monies to fund “Pilot” of pathways that aren’t NG-12 compliant and if improve conversation then we change the system if not go back to original

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  • LOCUMS TAKE NOTE-----THIS IS WHAT YOU SHOULD EXPECT WHEN THE REGULAR GPs TAKE THEIR LONG AWAITED SUMMER BREAK.

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  • if bloods/FIT test needed then it is best organised by the clinicain who wants it and who need to see the result. Simply e-mail/text/post out the relevent forms. This morning I have " please do weekly U+Es and ring results through to my private secretary".

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  • Which is why every general practice should be resourced and supported to provide phlebotomy services.

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  • When you say GPs should be properly resourced to do any work, the impression you create is that the GPs have capacity but need to be paid to do anything extra. It is not the case that GPs have extra capacity. We also have a backlog to clear. This should be made clear by BMA. Then let CCGs and hospitals work out how to ensure any extra work is carried out.

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  • It is obvious that NHSE do not know what they are doing. (Nothing new there!!) They are quite happy for patients to go around in circles seeing no-one and achieving nothing except suffering in silence.
    The BMA and Royal Colleges must now openly rebel against NHSE. CQC will have a field day fining hospitals and practices for non performance of duties, something neither can do because of NHSE's inane and irresponsible approach.
    Because they failed to isolate COVID patients from other patients (by zoning specific sites as COVID ony care) they have facilitated the complete overwhelming of the NHS. The mistakes lay completely at their door but they are trying to justify their errors and compounding them with these new ridiculous directions.

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  • watchdoc | GP Partner/Principal26 Jun 2020 10:32am

    " please do weekly U+Es and ring results through to my private secretary".

    er.......NO.

    YOU WANT - YOU DO IT !

    i don't send patients to you saying "please check their blood pressure and phone the surgery with the figures"

    imagine the uproar if we did !!

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