Tips to help GPs implement NICE cancer referral guidance

NICE's guidance for recognition and referral of suspected cancer contains over 200 recommendations. Macmillan Cancer Support has a useful document to help GPs implement these, explains Professor Willie Hamilton.

Macmillan provides tips on implementing NICE guidance on suspected cancer, including access to tests such as MRI scans (above)
Macmillan provides tips on implementing NICE guidance on suspected cancer, including access to tests such as MRI scans (above)

How many times have you looked at ‘War and Peace’ on your bookshelf, reflected for a moment, and then sheepishly selected a book half the size?

Similar feelings arise when you look at NG12, the 2015 NICE guidance for recognition and referral of suspected cancer. Despite containing over 3,000 pages and over 200 recommendations, we all know the subject is important – and won’t go away.

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 This article has been funded by Macmillan for GP Connect

However, even more important than reading the recommendations, is implementing them. Here Macmillan Cancer Support has been a real help.

Support for GPs

Macmillan has always been very strong in supporting the GP community, and another example of this is its Top tips for GPs on how to implement NG12, which has been pulled together by the Macmillan GP Community.

It separates out the problems with implementation into easily digestible chunks, and offers guidance as to how they can be solved. Even better, the document is full of case studies – some successes, some new initiatives which are being tested and some failures. As ever, we learn at least as much from the failures as from the successes.

One recurring theme running through almost all the case studies is the need for communication. Of course that’s obvious, but we’ve all been in rooms where there are either the wrong people round the table, or the right ones – who aren’t listening. Many of the successes build on a common feeling of a need to sort out implementation where primary care, secondary care and management all agree that ‘something must be done’.

Equally the ‘failures’ seem to arise from a feeling from one or more of the stakeholders that unnecessary (or worse, inappropriate) change is being foisted on them. This seems to be mostly in the areas which stimulated the most debate post-publication– if the policy change was controversial, then the controversy doesn’t go away at a local level.

Redesigning pathways

In addition to the case studies, there are handy tips on how to model demand, how to redesign pathways and how to redesign forms. The document has several links embedded, and a really helpful series of new documents in an Appendix.

This should save several CCGs from reinventing the wheel. Many of the forms have clearly benefitted from patient input, and to have a whole section devoted to how patients can be involved is great.

Finally, the document is honest: the editorial team have clearly decided on a warts and all policy. Initiatives that didn’t work are given their place, and reasons for their lack of success outlined.

I’ve only two tips of my own to add.

The NICE guidance is based on evidence to a large degree, but all the recommendations seem to have common sense at their core (I would say that; I led on NG12). The GP community by and large liked the recommendations, as they chimed with what we GPs were doing already. So, although NG12 brings change in its wake, it’s sensible change. Trust it, and trust yourselves, when it’s wrong.

And my second tip? Try ‘The Death of Ivan Ilyich’. It’s Tolstoy, and much much shorter. 

  • Professor Willie Hamilton is professor of primary care diagnostics at the University of Exeter

Download Macmillan's Top Tips for GPs: Implementing the NG12 NICE Guidelines for Suspected Cancer

Picture: iStock

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