Direct access to cancer diagnostics: the promise and perils of bypassing GPsBMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1917 (Published 22 August 2023) Cite this as: BMJ 2023;382:p1917
- Azeem Majeed, professor of primary care and public health1
The Secretary of State for Health and Social Care, Steve Barclay, has confirmed the UK government is considering plans to allow patients to bypass their GP and directly access some diagnostic tests for suspected cancer.1
The motivation behind this proposal seems to stem from the substantial delays some patients experience in obtaining GP appointments.2 If patients with potential cancer symptoms can bypass these waiting times, this could lead to earlier detection and treatment of cancers, thus potentially improving clinical outcomes. But the wait to see GPs—which could be reduced through greater investment in general practice—is only one factor in the diagnostic pathway. Even after referral, patients can wait for a long period before they receive a diagnosis and start their treatment.3
Hence, while obtaining a GP appointment can be a factor in a delayed referral for specialist cancer assessment, it is not the only holdup in the diagnostic pathway. An effective solution to improving the speed at which patients receive treatment for cancer should look at the entire patient journey, from the appearance of the first symptom to the start of treatment.
The example of breast cancer provided by Steve Barclay suggests that the plan may not be for every clinical area, but rather for cases where a direct referral to scans or specialists is a common outcome after a GP consultation. But not all symptoms or conditions can be fast tracked in this way, and careful implementation is needed to avoid inappropriate referrals Even for breast symptoms, appropriate clinical assessment is needed—such as via a telephone or video appointment with the breast clinic—to ensure the right tests are ordered so that diagnostic units are not overwhelmed with requests for unnecessary tests.
It will also be essential to have a feedback mechanism in place for patients who receive scans and other tests, especially if the results of investigations are normal. They might still need to see a GP or specialist for further evaluation of their symptoms.4 This is an often overlooked, but crucial aspect of any rapid access healthcare pathway. If a patient undergoes imaging and nothing abnormal is found, there needs to be a clear pathway for the next steps. Leaving a patient without guidance after a negative test can result in increased anxiety and uncertainty, and may delay further evaluation of their medical problems.
Although the intentions behind this plan seem well founded its successful implementation will rely heavily on careful planning, adequate resourcing, infrastructure, training and clear communication to professionals and the public so that both groups are aware of and understand the changes. It will also be essential to ensure that the public perceives these changes as beneficial and trust the new system. If patients feel that they are being denied access to their GP or that they are being pushed through a system without proper specialist assessment, this could lead to decreased trust in health services and potentially to lower uptake of the new care pathway and poorer clinical outcomes.
It is always important in healthcare to balance efficiency and cost-effectiveness with the provision of high quality, patient centred care. The clinical and cost-effectiveness of the new diagnostic pathways therefore needs to be compared with alternative solutions such as investing more in core NHS general practice services to create greater capacity and allow primary care teams to deal more quickly with patients who present with symptoms of suspected cancer.
Competing interests: none declared.
Acknowledgments: AM is supported by the NIHR Applied Research Collaboration NW London. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.