New NICE GP guidelines have huge ambition and potential

Submitted by CBCSG Member Pat Jennings


Category: Science blog June 23, 2015 


Dr Richard Roope, a practising GP and clinical lead for cancer at Cancer Research UK and the Royal College of General Practice, shares his thoughts on the new National Institute of Health and Care Excellence (NICE) urgent referral guidelines for suspected cancer.

Each year, as GPs, we see hundreds – if not thousands – of patients with potential cancer symptoms. Thankfully, on average fewer than eight of them* will turn out to have cancer.

The most important way we can help these people is to make sure they’re diagnosed promptly.

Clearly that poses a challenge for GPs – how do we spot patients whose symptoms are most likely to be cancer, among the thousands of others who won’t have cancer, and refer the right ones for diagnostic tests? And how do we do this as quickly as possible?

Today NICE has taken a big step forward towards helping us do exactly that.

Richard Roope - 200px

Dr Richard Roope: “These guidelines have great potential”

It has published new, updated guidelines to help us refer patients with potential cancer symptoms, which now incorporate the latest evidence on exactly the kind of things to look out for. This has been possible partly because of the big jump in available evidence on which symptoms are linked with cancer.

But even better, the guidelines should also give us more freedom to send our patients to see specialists, cutting out delays faced by some patients.

Referring patients sooner has many benefits. It can help reduce the number of GP appointments patients have before they see a specialist, which in turn frees up our time for others.

But ultimately, it could also help more patients to be diagnosed at an early stage, which will boost their chances of long-term survival.

So how will the new guidelines affect what GPs do? What do the changes mean for GPs and patients? And will the NHS cope with the changes?

How do GPs refer patients?

There are many ways that GPs can refer patients – for example, via a routine referral, which comes with a right to start treatment within 18 weeks.

But we have an option that’s specifically designed to diagnose cancer quickly: the ‘two-week wait’ urgent referral route, introduced in 2000. We can use this when a patient has potential cancer symptoms that aren’t immediately life-threatening, but need urgent investigation, and patients referred via this route should be seen by a specialist within two weeks.

By detailing the symptoms most likely to be linked to cancer, the new guidelines help us work out who to refer for further tests and investigations under this system.

But only about 10 out of every 100 patients referred under the two-week wait go on to be diagnosed with cancer. Obviously this statistic is reassuring to anyone we refer for tests, but it also highlights the challenges that GPs, and the NHS as a whole, faces in spotting potential cancer symptoms.

Getting this right is important, particularly in light of recent suggestions that the UK’s lower cancer survival is partly linked to GPs being less likely to refer patients early. And it’s not just about diagnosing cancer – people with these symptoms may well have other illnesses – so referring them quickly will help spot these too, or put people’s minds at rest if it’s something less serious.

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