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Updated cancer guidance may lead to system breakdown, RCGP says

23 June 2015

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GPs fear that the NHS will struggle cope with the increased number of cancer referrals which may result from the updated guidance on detecting and referring cancer patients.

The National Institute for Health and Care Excellence (NICE) guidelines, which take over from its 2005 predecessor, are designed to offer simplified guidance to support GPs and primary care professionals in detection and referral as well as information to help the general public recognise the most common possible signs of cancer so they can visit their doctor sooner.

This was predicted by health experts to save thousands of lives in England if the NHS follows it, however the Royal College of GPs (RCGP) is concerned that NICE hasn’t properly considered that secondary care cannot cope with the increased volume of referrals.

Dr Maureen Baker, chair of the RCGP, said: “At face value, this appears to be very good news that patients will find encouraging and reassuring. However, we query whether NICE has assessed the potential volume of patients that will be affected by this change and are worried that the system overall may well not be able to cope with the increased volume of referrals. If there is sufficient diagnostic capacity, such as scans and imaging, in secondary care then that works to everyone’s advantage.

“But if the onward services cannot cope with the work, we run the risk of patients actually having to wait longer for investigations and diagnosis, causing them further anxiety and stress,” she said.

She also warned that since there has not been a phased introduction of these guidelines, the referral pathways used by GPs could change suddenly, “meaning that services such as diagnostics, clinics and administration services could get swamped.”

“We would welcome reassurance from NICE that it has carried out modelling or risk assessments to identify possible adverse consequences and come up with local plans to mitigate any risks,” she said.

If this has not happened, Baker said that we need to see structured risk assessments or pilot schemes within individual health economies to test out the impact of this guidance on local services in general practice, secondary care, and particularly radiology.

The new guidance was designed to be easier to use and has clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made.

Dr Steve Hajioff, a director of public health, chaired the independent group of experts which developed the guidance for NICE. He said: “Cancer is an incredibly common disease, which can leave death and heartbreak in its wake. There are more than 200 different cancer types and in excess of 300,000 people are diagnosed each year in the UK.

“This sounds like a lot, but GPs will only see a handful of patients with some form of cancer every year. With the disease sharing many symptoms with more common and much less serious conditions, this makes it even more difficult for doctors.

“No GP wants to miss a cancer diagnosis. This guideline will support them by encouraging them to think about the possibility of cancer sooner. Not only will it speed up the process of referral, enabling faster diagnosis, but its recommendations to monitor people with less severe signs and symptoms will mean fewer cancers are missed,” he said.

See the new guidance here