Self referral for cancer tests is to be piloted in EnglandBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h185 (Published 13 January 2015) Cite this as: BMJ 2015;350:h185
Patients will have the option to refer themselves for diagnostic tests without going through a GP as part of an early diagnosis programme for cancer, NHS England has announced.
It also announced that a new independent taskforce will develop a five year action plan for cancer services to improve survival rates and that stereotactic ablative radiotherapy will be made more widely available to patients with cancer in England.
The early diagnosis programme, run jointly with Cancer Research UK and Macmillan Cancer Support, will test new approaches to expedite cancer diagnosis. The programme has identified more than 60 potential projects to tackle late diagnosis, which will be led locally by NHS teams. They will be evaluated and then could be implemented nationally from 2016-17.
The projects include giving GPs direct access to diagnostic tests, such as computerised tomography and ultrasonography, lowering referral thresholds for GPs, and creating bespoke clinics where people with unexplained symptoms can get a quick diagnosis. Other initiatives are to improve multidisciplinary diagnostic centres, where patients can have several tests in the same place on the same day, and to enable pharmacists to refer patients for tests.
The taskforce, chaired by Harpal Kumar, chief executive of Cancer Research UK, aims to deliver the vision set out in the NHS’s five year plan published in October 2014, which called for better prevention, swifter diagnosis, and better treatment and aftercare for those diagnosed with cancer.1 2 The taskforce will also include clinicians and representatives from the Royal College of General Practitioners, Public Health England, and local councils and will publish its plan in the summer.
Maureen Baker, chair of the Royal College of General Practitioners, said in a statement, “We are prepared to look at all the proposals but in the case of self referral we would need to understand how it could work effectively without diverting resources from other services. GPs are already doing a very good job of appropriately referring our patients whom we suspect of having cancer. We are specialists in caring for the ‘whole person’ and many potential symptoms of cancer could be confused with other conditions that patients present with every day.”
Baker welcomed the early diagnosis programme and the proposal to create diagnostic centres that could do multiple tests in a single day. “Giving GPs direct, rapid access to diagnostic tools such as CT, MRI, and ultrasonography is something that the Royal College of General Practitioners has long been calling for and could make a real difference to our patients’ lives,” she said.
The number of patients with cancer who are eligible for stereotactic ablative radiotherapy will double to around 750 new patients a year with the extension of NHS England’s Commissioning through Evaluation programme. This follows a campaign led by former England rugby captain Lawrence Dallaglio to make this type of radiotherapy—which is more precise and potentially less damaging—more widely available. The programme will expand the range of cancers being treated to include oligometastatic disease, primary liver tumours, spinal tumours, the re-irradiation of cancers in the pelvis, and other selected indications.
President of the Royal College of Radiologists, Giles Maskell, said that NHS radiology services are already overburdened with over 300 000 patients waiting more than a month for test results. “We hope that the taskforce will rapidly conclude that investment in more radiologists is an essential component of any strategy to improve outcomes for patients.” He added that the focus on advanced radiotherapy was welcome but that investment was required not just in stereotactic ablative radiotherapy but also in other treatments, including image guided radiotherapy, intensity modulated radiotherapy, and proton beam therapy.
Cancer survival rates in the UK have improved in recent years with half of patients with cancer now living for at least 10 years. But survival rates for most types of cancer remain below the European average and well below the best in Europe and other countries of comparable income.
NHS England’s chief executive, Simon Stevens, said in a statement “Cancer survival rates in England are at an all time high, but too many patients are still being diagnosed late—up to one in four only when they present in emergency departments. So it’s time for a fresh look at how we can do even better—with more focus on prevention, earlier diagnosis, and modern radiotherapy and other services so that over the next five years we can save at least 8000 more lives a year.”
Cite this as: BMJ 2015;350:h185