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GPs to have direct access to ‘fast-track’ cancer tests from this month

GPs to have direct access to ‘fast-track’ cancer tests from this month

All GP practices in England will be able to directly order fast-track cancer diagnostic tests for their patients starting from this month, NHS England has announced.

The tests will be available for ‘patients with concerning symptoms’ who ‘fall outside the NICE guideline threshold for an urgent suspected cancer referral’.

Under the national rollout of ‘fast-track testing’, all GP teams across England will be able to ‘directly order CT scans, ultrasounds or brain MRIs’ for this group of patients, NHS England said.

It added that the scheme aims to cut waiting times and speed up cancer diagnosis or all-clear for patients and could mean that ‘tens of thousands of cancers could be detected sooner each year’.

‘Hundreds of thousands’ of initial hospital appointments could also be freed up by reducing the need for a specialist consultation first, it said.

Around 67,000 people with vague symptoms who would usually be diagnosed through non-urgent testing will now be eligible for the fast-track scheme, while GPs will continue to follow NICE guidelines for referring patients to urgent cancer pathways, it added.

NHS England today said: ‘From this month, every GP team will be able to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms, but who fall outside the NICE guideline threshold for an urgent suspected cancer referral.

‘Around one in five cancer cases are detected after routine testing following referral to a hospital specialist, meaning some people can wait much longer for a diagnosis.’

It added that the new scheme ‘will allow GPs to order these checks directly, helping to cut down wait times to as little as four weeks’.

NHS England said that the first phase of the scheme will tackle urgent cancer referral pathways while phase two will be built up in 2023/24 to ‘include a wider range of tests which will involve dialogues with GPs, integrated care boards and key stakeholders’.

The scans and checks will be delivered by existing hospital diagnostic services and ‘one-stop shop’ Community Diagnostic Centres and NHS England will ‘support primary care teams to boost the number of GP direct access tests available’ over time, it added.

Speaking at the NHS Providers annual conference in Liverpool today, NHS chief executive Amanda Pritchard is expected to say: ‘GPs are already referring record numbers of patients for urgent cancer referrals, so much so that the shortfall in people coming forward for cancer checks caused by the pandemic has now been eradicated.

‘This new initiative builds on that progress, supporting GPs to provide more opportunities for testing across the country for people who have vague symptoms.’

Royal College of Radiologists president Dr Katharine Halliday added that while the expansion of direct access to diagnostic scans across all GP practices is ‘welcome’, GPs ‘aren’t radiologists’.

She said: ‘As scans become ever more complex, it’s essential that GPs are able to book the right scan, avoiding costly repeat scanning and devastating delays in treatment.’

RCGP chair Professor Martin Marshall said that direct access to diagnostic services is ‘a positive step’ but that ‘the devil will be in the detail as to how it will work in practice’.

He said: ‘It will be vital that alongside direct access to diagnostics, GPs receive appropriate support and additional training to interpret the test results and that relevant IT systems used for booking tests are integrated into those that GPs already use. 

‘We also need assurances that diagnostic hubs are appropriately staffed to cope with increased demand for testing – and that safeguards are put in place to prevent this new system inadvertently adding to the workload of already over-stretched GP teams.’

He added: ‘Ultimately what we need to improve cancer diagnosis is to increase the workforce across the NHS, including in primary care.’

NHS England committed to diagnosing three-quarters of cancers at stages one or two by 2028 as part of the Long-term Plan.

According to an analysis of the latest NHS data, the NHS is ‘diagnosing more patients with cancer at an earlier stage than ever before’.

It showed that last year, more than 100,000 patients were diagnosed with cancer at stages one or two when it is easier to treat – the highest proportion on record.

It comes as hospitals were ordered to reduce the number of patients waiting too long for cancer investigation in July amid GP referral rates one-fifth higher than before the pandemic.

And in June, NHS England announced a pilot scheme for community pharmacies in England to be asked to spot early signs of cancer and refer patients directly for scans.

Leading MPs warned in April that a lack of support for GP practices is ‘inhibiting’ the early diagnosis of cancer and recommended that the threshold for investigations should be lowered.

Meanwhile, the Government suggested earlier this year that patients who think they may have cancer could be given the option to self-refer for investigation without the need for a GP referral.


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Please note, only GPs are permitted to add comments to articles

Mark Hambly 16 November, 2022 10:13 am

We have had direct access to 2ww radiology for a few years and the benefit is that you can get urgent imaging fast and for patients this is great. There is a box for use if you are very worried the patient has cancer but does not fulfil the referral criteria and being completely honest as a clinician I also like being able to get this information faster than previously. The issue I find is that the report – of course – comes back to me and then if high risk the patient needs to be referred under 2ww (as they would anyway), and if not still has unexplained concerning symptoms so quite often needs referral in any case (as they would anyway). It basically means that many cancer referrals just involve the additional work of an extra referral form (2ww radiology), an extra subsequent radiology report to process, an (extra) second consultation with the patient to discuss the results and frequently another referral (which would have been the only step 10 years ago).
The report talks about “hundreds of thousands” of appointment being saved at the hospital but each one is an extra appointment for the GP, an extra form to fill in and an extra radiology report to process. It’s basically a bit like a cancer A&G – a great idea but relentlessly increasing the clinical risk and workload burden with no recognition or payment to increase staff/hours.
Sorry to rant – first time I’ve commented on Pulse but every NHS “improvement” at the moment appears to be based around GP practices doing more, interspersed with articles about how overwhelmed we are!

Michael Mullineux 16 November, 2022 10:34 am

Totally agree MH – not so much a rant, rather a perfectly reasoned argument. This proposal is not a fix for cancer care in the UK with its well documented 2 week appointment delays, delays to treatment, oncologist and radiotherapy facility shortages, rather a MUS and incidentaloma minefield.

Patrufini Duffy 16 November, 2022 2:50 pm

They basically are using you as the 2ww Consultant. Free. Buck stops with you. And the patient has the report on their phone in anatomical jargon, with an incidentaloma. Free follow-up with you. What next? Who to refer? The scan is normal, you leave it and they get cancer 2 years later from something else. Don’t be fooled, it’s a lobster trap to save the hospital, not you. Refer it.

Finola ONeill 16 November, 2022 4:20 pm

NHSE: Managers with clueless ideas as always as not clinically trained
The delay for cancer is generally not imaging, and if it was whether it is us or the consultant requestng the imaging the same dealy would remain.
The delays are seeing a consultant and initating treatment/ having surgery. because these re much more time and services intensive; surgeru you need theatre time, theatre staff, beds, etc, etc.
Getting rapid scans for vague symptoms like fatigue is daft.
What are going to do; yearly whole body scans for the population to detect early cancer.
Obesity increases the risk of all cancers. Also causes type 2 diabetes and so IHS, CVA. Obesity also causes much of the OA people are sitting on lists for.
Government fancy tacking this? Fast food tax, sugar tax, processed food tax; using revenue to subsidise fruit and veg and wholefoods.
No. Too much lobbying from the fast food industry.
This isn’t about health.
It’s about the healhtcare industry. Diagnostic centres; lots of private healthcare interests there plus the digital tech involved.
Scans don’t diagnose; doctors do. Gps and consultants by taking a good history, having good clinical skills, experience and patient being able to access our time.
Now Foxtrot Oscar NHSE; can’t stand you.
PCNs, social prescribers, wellbeing practitioners, pharmacist or patient activated scan requests.
Just pay more doctors and nurses and also pay carers properly so we can move the bedblock, get beds moving and unlock the secondary care gridlock.
Amanda Pritchard promised a 60% reduction in NHSE; when is that happening?