NICE GP cancer referral advice threatens to swamp services, warns RCGP

The RCGP has called for NICE to produce evidence that its new cancer guideline, which lowers the referral threshold for GPs, will not flood services with referrals.

Dr Maureen Baker: warning over impact of NICE cancer guidance (Photo: Pete Hill)
Dr Maureen Baker: warning over impact of NICE cancer guidance (Photo: Pete Hill)

NICE issued new guidance to GPs earlier this week, meaning GPs will be able to refer patients with a 3% risk of cancer rather than the previous 5% threshold.

But the RCGP has questioned this move, warning it works ‘at face value’ but the current referrals system may not be able to cope with the sudden change.

‘We query whether NICE has assessed the potential volume of patients that will be affected by this change and are worried that the system overall may well not be able to cope with the increased volume of referrals,’ said RCGP chairwoman Dr Maureen Baker.

GP cancer referral

‘We support moving to 3% thresholds, but only if local services can accommodate such a change in practice,' she said.

Experts who developed the NICE guidance previously told GPOnline that direct access for GPs to diagnostic tests were in place in some areas, but CCGs would need to bolster their capacity for referrals.

Such a major change to cancer testing guidance could overwhelm the referral process, said Dr Baker, who called for evidence that NICE had considered the impact on local services.

‘As there has not been a phased introduction of these guidelines, the pathways used by GPs for referring patients for all conditions could change overnight, meaning that services such as diagnostics, clinics and administration services could get swamped,’ she said.

NICE guidance impact

‘We would welcome reassurance from NICE that it has carried out modelling or risk assessments to identify possible adverse consequences and come up with local plans to mitigate any risks,' Dr Baker said.

‘If not, we need to see structured risk assessments or pilot schemes within individual health economies to test out what impact this will have on local services – both in general practice and secondary care, particularly radiology.’

Lack of capacity for tests could lead to longer waiting times for patients, she said, adding: ‘It would be regrettable if something that was so well-intentioned resulted in patients being worse off.’

The comments come after Dr Baker said that the cancer referral system needed ‘major changes’ at a conference earlier this month.

A spokeswoman from NICE confirmed that the scheme is likely to increase the number of referrals for testing, but said it is ‘beyond our power to organise and carry out pilot schemes’.

‘We have a NICE field team who will work with local NHS bodies to support them in implementing the guidance,’ she said. NICE has also produced a costing statement for local services and ‘hope that relevant national health bodies and local CCGs take our guideline on board when considering funding for services’.

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