New guidance for primary and secondar care on on urgent cancer diagnostics during the pandemic says that 'increasing the capacity of primary care networks to perform initial diagnostic tests such as X-ray and ultrasound' should be considered as part of local COVID-19 response plans. It says this would help to reduce hospital attendances and protect patients from the coronavirus.
The guidance provides a range of suggestions on how local pathways could be adapted during the pandemic. NHS England said that measures such as infection control measures, social distancing, additional COVID-19 testing and self-isolation have impacted on 'productivity' and the number of patients that can be seen.
The guidance says that clinical triage is 'essential' to ensure that patients get the 'right tests at the right time'.
It recommends that 'where available and clinically appropriate' GPs should have direct access to high-sensitivity diagnostics, such as ultrasound for suspected gynaecological cancers or sarcoma and CT or MRI for suspected brain tumours, before patients are referred into secondary care.
It adds: 'In general, greater access to straight-to-test pathways should be made available to streamline services.'
Referrals for diagnostics
The guidance makes clear that once patients are referred into secondary care, if diagnostic tests are delayed for any reason hospital trusts are responsible for safety netting and following-up patients.
'Local systems should apply safety-netting for those not immediately having investigations, with responsibility residing in provider trusts,' the document says.
It adds that patients should also receive 'clear, timely communications' if their diagnostic test is rescheduled or delayed.
If patients decline an appointment for a diagnostic test because of fears of contracting COVID-19 they should be offered a teleconsultation by the hospital to discuss the importance of the test. Patients should also be told what to do if their symptoms persist and the hospital should provide them with a contact number through which they can rebook their test appointment.
Red flag symptoms
NHS England also stresses that red flag symptoms for cancer should not be ignored if they overlap with COVID-19 symptoms.
The guidance says that NICE's NG12 guidance should be used to initiate a cancer referral. It adds: 'Some NG12 symptom criteria overlap with symptoms for COVID-19. GPs should not rule out cancer because of this overlap and should consider these symptoms in combination with any other cancer symptoms, family history or other risk factors.'
If patients present with suspected cancer and COVID-19 comorbidity they should receive a coronavirus swab test as part of their referral.
The document provides a list of how COVID-19 symptoms overlap with the cancer signs and symptoms to consider from the NICE NG12 guidance.