Patients who think they may have cancer could be given the option to self-refer for investigation without the need for a GP referral, the Government has suggested.
A public call for evidence on a 10-year cancer plan, launched last week (4 February) listed this as a future option, alongside allowing pharmacists to refer patients with suspected cancers.
Introducing the consultation, the Government said it was ‘committed to accelerating progress’, for example via ‘working with primary care to trial new routes into the system via community pharmacy and self-referral’.
Meanwhile, in an accompanying speech, health secretary Sajid Javid said the evidence call ‘demonstrates the ambitious plans that we have for the next decade’, which could include ‘using community pharmacy and perhaps even self-referral’.
The news comes as the Government has already announced plans to expand a number of community diagnostic centres to speed up diagnoses – although the existing CDCs currently require a GP referral.
‘At least’ 100 community diagnostic centres are planned to be in place over the next three years, with 66 by the end of 2021/22 and an ambition to reach more than 160 across the country, the plan for clearing the NHS elective care backlog said yesterday.
It also set out plans to reduce diagnostic waiting times, with the aim of:
- At least 95% of patients receiving tests within six weeks by March 2025;
- Delivering the ‘cancer faster diagnosis standard’, with at least 75% of urgent cancer referrals receiving a diagnosis within 28 days by March 2024; and
- Returning the 62-day backlog to pre-pandemic levels by March 2023.
Professor Willie Hamilton, professor in primary care diagnostics at the University of Exeter, who has a particular expertise in cancer, noted that the idea of self-referral for cancer investigation had been ‘bubbling up for years’, having now ‘reached the surface’.
He told Pulse: ‘My stance is that with appropriate safeguards and very thorough entry criteria – for example, you can self-refer with breast lumps or certain lung symptoms – then I don’t have a problem with patients bypassing the GP.’
Meanwhile, addressing GP concern that self-referral could lead to cancer investigation resources being taken up unnecessarily, he added: ‘There is some strength to that argument but in cancer the gatekeeper theory may have been counterproductive.
‘GPs are brilliant when it’s not cancer but the people who suffer from the gatekeeping are those who do have cancer.’
But Professor Hamilton added: ‘I think most patients with cancer will benefit from seeing a GP and I don’t think there will be a rush to self-refer.
‘I think most people will value seeing their GP and I don’t think that many people will bypass that step.’
Click to complete relevant cancer CPD modules on Pulse Learning.
READERS' COMMENTS [20]
Please note, only GPs are permitted to add comments to articles
I assume secondary care will reject their referrals to waiting list manage the way they reject ours if a box isn’t ticked or unticked
…”doesn’t think there will be a rush”…well obviously because no one we see thinks they have cancer.
I do hope they do this – its going to be fun watching it implode.
Great idea. **Open up the mole clinic in summer, and breast pathway. Save us all a lot of hassle.
__But you won’t.
Because you still want us to hold them back, and take the stick for you.
**** me, this is hilarious.
PMSL, as the kids would say.
Pull up a sandbag and crack open the popcorn for this imminent cluster****.
Has someone been eating magic mushrooms.Will be fun watching it implode will be a sh@@ storm clearing up the mess.
Can I have my annual whole body scan please?
This is hilarious. Once they’re flooded with our hysterical heartsink hypochondriacs (that we have pluckily kept from their doors all these years) they’ll realise with horror what a clown car crash of a boneheaded idea this actually is.
I guess it depends
How many ladies place any value whatsoever on the GP consultation prior to referral ? What proportion of lumps are not referred, and how many of those actually turn out to have cancer. The NICE guidelines say refer urgently over 30 years age, effectively condemning ladies under 30 with cancer, good luck following those. Also worth considering how difficult getting consultations can be these days.
SO do ladies with a lump wish to have their ideas concerns and expectations explored, or do they think those should be obvious to anyone. How important do they feel someone considering their physical psychological and social is, and are they prepared to delay a scan to have this considered.I suppose it boils down to whether you consider we should allow those who pay for the service to have any say in what it delivers.
Surprisingly Prof didn’t say anything about whether this has been tried
If not my vote is to give it a go and see what happens
What about medics themselves, do those with access through contacts or money book in to discuss biological individual and contextual or do they just get a scan as fast as possible.
Perhaps we should experiment by offering ladies a choice and see what happens
I look forward to this. Abut the first thing the government has suggested that doesn’t actually look to increase our workload. So long as the “community pharmacist referrals” don’t come or way as they normally do.
Oh and all the nightmare ?incidental finding stuff will still come our way.
Mmmmmm.
I say they have to go back to the pharmacist to ask bout the incidental findings.
This plan should be for skin and breast lumps only.
skin can be telederm ref and breast lumps fine.
All the nondescript US, CT, MRI results.
Don’t want the floodgate on those indeterminate results coming back to us for the unclear follow up.
Actually endoscopies with a qIT following proformas could work too.
No rush to self-refer? They said that about e-consults too….
Depending on ones point of view this could be viable or hilarious, see many opinions above, my worry is that this is simply further evidence that HMG regards GPs as an expensive irrelevance who can be dispensed with
presumably, prior to referring themselves, they will arrange their own bloods, xrays, scans, endoscopies, fit tests etc etc etc.
presumably they will be able to refer themselves to the dermatologist and the plastic surgeon at the same time to have that mole removed, to avoid a nasty scar spoiling their beautiful, blemish free, skin.
will they copy their local friendly gp surgeries in with all these expensive, irrelevant tests, so that when they find they haven’t got cancer, we will know what tests have, (or haven’t) been done ?
presumably, all the patients we see with potential cancer will be in the same (lengthening) queue as the “worried well”
presumably, they will be able to sign themselves off sick with “anxiety” while they await their (normal) xrays, blood tests, whole body scans, endoscopies etc etc etc
presumably they will be able to prescribe their own diazepam, zopiclone, sertraline etc etc to cover their anxiety, depression etc while they are sitting in the 10 year queue to be told “nothing wrong”.
presumably they will be able to refer themselves for a second opinion when they don’t like, or don’t believe, the first opinion !
presumably they will write their own expedite letters.
presumably they will be able to sue the hospital for any harm that befalls them while on the 10 year waiting list (“not a GP problem, your honour – i have never seen the patient with this problem”)
what a stupid idea. for god’s sake – get a grip.
grow up !!
and presumably jo public won’t object when income tax goes up to 90p to pay for the “all you can eat for free” buffet
“it boils down to whether you consider we should allow those who pay for the service to have any say in what it delivers.”
I guess that is the problem isn’t it…..they are not really paying (enough) for it – which brings us to DJ’s point about income tax rates.
Caviar service for beans on toast money
I suggested this to the chief executive of our local hospital quite a few years ago, and he said it was a stupid idea.
I think he was right.
In socially responsible Scandinavian countries this works. But in the pampered, I cant cope, I want it now UK not a chance. It would be swamped within a few weeks and the default – ‘go and see your GP’.
Call me sensitive, but i am beginning to suspect that there is a possibility that not everyone is as evangelically gung ho for this as me.
If I were still a fund holder I would pay for this. though I know our local chief exec wouldn’t, which just goes to show how much they know about medicine
How about a compromise, how about practices being given a choice to opt in or out. Those that opt in, can send a lady ringing with a breast lump straight for a scan, the luddites can , well they can ………………
How about ladies over 55 eligible for a screening scan, but who have not yet had one, being able to self refer, if they find a lump.
There is absolutely no sane reason, to raise any objection whatsoever to that.
Objections awaited
Ask yourselves, if it was my daughter or wife, how quick would I want the scan, how much irrelevant unnecessary consulting and referring would I tolerate
Thomas R – I’ve been really really thinking of a reason to object; here is what I have come up with (to play devils advocate really):
1 – We see loads of patients with lumpiness rather than a lump
2 – I see loads of patients with breast pain, who tell the receptionist that they have a lump to be seen on the same day – they don’t currently get referred.
3 – If you ONLY include a lump in the self referral pathway, you might discourage women from presenting to their GP with less objective signs (like skin changes) because they think that a lump is the only important factor.
But overall I think it is a good idea to trial and particularly good for breast cancer. I’m not sure it will work as well for less objective things like diarrhoea or nausea.
The main difference needs to be that the first level of review should be cheaper than the cost of a GP appointment. One of the most absurd things about our health service is they seem to value ‘an appointment in outpatients’ ridiculously high regardless of what is done. Someone turning up with breast pain and no other red flags, should be able to be discharged within 10 mins, without seeing a consultant, without any extra tests . And it should cost the taxpayer about £20. If they can get that right, then the system will work.
The main issue here is one of opportunity cost.
Suppose you are going to create a few thousand extra hours of scanning capacity.
The question is whether that new capacity is best used to speed up existing diagnostic pathways, or to provide a new service for self referral.
My pretty certain bet is that a cost-effectiveness evaluation would not favour setting up a new service.
Oh dear. Has anyone given this any thought at all?