Exclusive Diagnostic services for GPs to refer patients with non-specific cancer symptoms are facing closure around the country after a report did not find clear evidence of their cost effectiveness or impact.
The evaluation commissioned by NHS England concluded ‘it is not possible to say with certainty whether [non-specific symptom] NSS pathways are cost-effective or not’.
It found variation between the 115 centres but overall while there were some cost savings in reduced GP and outpatient appointments and emergency department visits, these were outweighed by the expense of further tests.
Given the lack of evidence, while it is expected non-specific symptom (NSS) services would continue in the short term ‘there are question marks about how funding would be sustained’, the report seen by Pulse concluded.
It will now be up to ICBs to commit to future resource for the services first set up in 2021 as part of the NHS England Faster Diagnosis Programme.
‘However in the absence of conclusive impact and economic evaluation results, it was noted that this might be difficult,’ the report noted.
Between January 2021 and March 2024 there were 65,000 referrals to NSS services, the report found.
Pulse has learned that future funding for some of the 115 NSS services around the country has already been pulled.
Critics of the decision said the impact of the services is difficult to assess and cutting them will leave GPs struggling to access diagnostic tests for patients who do not fit urgent referral criteria but who have unexplained symptoms.
Dr Cemile Maden, a GP and lead for the West Hertfordshire NSS cancer service, said their service had just received notice it would not be recommissioned for financial reasons.
She had heard similar from other services around the country including one that had been running for almost 10 years and was one of the pioneers of NSS.
‘It’s been devastating news for staff and huge loss for patients. When I audited patients that we had diagnosed with cancer, over 70% had no other suspected cancer pathway to be referred through.’
She added: ‘Our ICB are putting in place a direct access to CT instead so that should pick up some of the cancers, but this has its disadvantages with GP’s receiving reports without the multidisciplinary team expertise.’
The MDT would have access to prior imaging and can see what changes are new, what are not and which require further investigation, for example with renal cysts and lung nodules. ‘An isolated report may generate additional stress and anxiety.’
‘With a single scan, the guidance may be for surveillance, characterisation or even biopsy causing anxiety to the patient and additional cost to the NHS.
‘It’s hard to financially model these scenarios without experts looking at the data. Most of this is uncoded information so difficult to analyse.’
Another GP working in a rapid diagnostic centre (RDC) who did not want to be named, told Pulse that the NSS report was not helpful and many of those working in services felt there had been insufficient consultation and data collection.
Funding in his area for the NSS service has been secured until March 2026 but only after the Cancer Alliance stepped in.
A recent six-month review of the service had found the service popular with patients, primary and secondary care
‘We have also shown it to be cost effective with the cost just over £400 per referral, which stacks up favourably with, for example, a single A&E attendance,’ he added.
ICBs are being asked to make cuts of 50% but while disinvesting will help their budgets balance initially ‘it will undoubtedly result in higher costs to the whole system, delays in diagnosis not only of cancer, but also the non-cancer diagnoses that are referred on’.
There are also diagnoses that help the GP can help manage to prevent future illness and expense such as aorta aneurysms and coronary artery calcification, he noted.
‘It would appear that unless there is central, ring-fenced funding, there is no certainty that the RDCs will be continuing in their current form beyond March 2026, which will result in a lose, lose, lose situation.’
An NHS England spokesperson said: ‘Now these services have been established across the country, they are transferring to local commissioning – NHS England will support ICBs with these services while continuing to prioritise faster diagnosis for cancer for patients.’
