NHS To Give GPs Access To Fast-Track Cancer Testing

It has been announced that all GP teams will start to be able to directly order CT scans, ultrasounds, and brain MRIs for patients who have concerning symptoms but fall outside of the threshold for an urgent suspected cancer referral.

This means that “tens of thousands” of cancers could be detected sooner each year following the national roll out of fast-track testing.

Expansion of the Direct Access Scheme

There have been many stories about the unprecedented NHS backlog because of the pandemic. This includes exceptionally long wait times for hospital appointments which may be a vital part of the process of detecting cancer.

Whilst over recent years more GPs have been able to directly book scans, it has not been made available to all of them.

The Direct Access Scheme will provide national uniformity as all GPs across the country will have the ability to book cancer tests on behalf of their patients, even where a patient’s presenting symptoms do not clearly indicate a specific type of cancer.

Currently, only one in five cancer cases is diagnosed through an urgent suspected cancer referral and two out of every five cases are not diagnosed until they are at a later stage.

Patients with less clear symptoms face very long waits (particularly post-pandemic) and are often only diagnosed after presenting at Accident & Emergency or waiting a very long time for non-urgent hospital testing.

It is hoped that the expansion of the scheme will significantly reduce waiting times, speed up the diagnostic process and ensure that those patients who do not strictly meet the NICE criteria for an urgent hospital referral are not ‘left behind’.

The scheme is to be split up into phases. The first phase will tackle urgent cancer referral pathways. The second phase will be built up in 2023/2024 to include a wider range of testing and the involvement of many stakeholders.

Testing will be delivered by existing hospital diagnostic services and ‘one-stop shop’ Community Diagnostic Centres. There are plans to open up to 160 of these centres in total over the next two years.

NHS England commented that:

Risks vs benefits?

There is no doubt that the planned expansion of the Direct Access Scheme is ambitious and could lead to several positive changes in the way patients with suspected cancer are assisted in the community.

Whilst in theory this could lead to quicker diagnosis, less invasive treatment, and save more lives by cutting out initial hospital appointments and sending patients straight to testing, there are some practical concerns that must be kept under close review.

Firstly, concerns have been raised that GPs (despite years of experience) are not radiologists. The scheme will place on GPs the responsibility to ensure that they are:

Arguably, GPs will require additional training to be able to confidently take these steps, particularly in respect of interpreting test results correctly. This will only increase the costs burden on the NHS.

Secondly, it is well-known that GPs are already overstretched and carry significant individual workloads. Patients often struggle to get through to their GP on most days and if able to, still wait a number of weeks (if not longer) for an appointment. It is very worrying that additional burden and responsibility will be placed on GPs nationwide, with no recognition or payment to increase staff and working hours.

Claims against GPs

It is entirely possible that the expansion of this scheme will lead to an increase in clinical negligence claims against individual GPs and practices.

However, much of this will depend on how well individual GPs and practice staff are supported through the transition by way of additional training, the introduction of appropriate policies/guidelines, whether the workforce will increase to deal with the increased demand, and ensuring that the correct IT infrastructure is in place to enable GPs across the country to easily book tests and review test results.