GPs to refer more patients with low-risk cancer symptoms under new NICE guidance
Summary: GPs are being urged to refer and test thousands more patients for potential cancers under new guidelines rubber-stamped by NICE experts today.
The guidelines take a radical new approach, with the aim of giving GPs greater freedom to investigate patients with potential signs and symptoms of cancer and decrease the time before diagnosis.
The guidelines recommend GPs are able to request some ‘direct access’ tests urgently – within two weeks or even 48 hours for some rare cancers - which NICE advisors said would streamline the patient’s journey.
But GP critics said the guidelines risked referring too many patients at very low risk of cancer and missing those at the greatest risk because the new symptoms-based approach does not take into account patients’ baseline risk.
The guidelines are expected to lead to an increase in urgent referrals for potential lung cancer, upper gastrointestinal (GI) cancers, such as stomach cancer, and bowel cancer in particular - although NICE has not forecast exactly how many more patients would expect to go through these pathways.
Despite this, NICE said any increased costs would likely be evened out by savings resulting from diagnosing people earlier, so that their treatment is less complicated and more likely to be life-saving.
The main recommendations are largely unchanged from the draft guidelines published last November, and effectively lower the risk threshold at which patients are referred for cancer investigation – from a positive predictive value (PPV) of roughly 5% to 3% – as well as getting GPs to order tests for people with clusters of symptoms suggestive of potential cancer but with a lower PPV than this.
Professor Willie Hamilton, clinical lead for the guidelines development group and a GP in Exeter, told Pulse the guidelines should give GPs more flexibility to investigate when a patient’s presenting symptoms are only vaguely suggestive of cancer.
Professor Hamilton said: ‘GPs know the symptoms of cancer [but] what has been difficult up to now has been being able to act on that knowledge. There were patients with mild symptoms that just might have been cancer that it was more difficult to investigate.
‘So now that we have slightly increased both the types of tests and number of tests that are undertaken it is now easier for GPs to test.’
Professor Hamilton insisted the symptoms-based approach was not prescriptive and that he did not expect GPs to have to do much more work as a result of the recommendations to do more testing in primary care.
He said: ‘I don’t think it will be remotely unmanageable because some testing was already been going on, we’ve been doing blood tests, CA125 tests. We will have some responsibility for seeing the faecal occult blood test results, and making sure we act on the results. Similarly for gastroscopies.’
However Professor Julia Hippisley-Cox, professor of epidemiology and general practice at the University of Nottingham, said it was ‘disappointing’ that the guidelines panel had not addressed concerns over the complexity of recommendations.
Professor Hippisley-Cox, who has been working on producing the validated QCancer risk tool that has already been adopted on GP computer symptoms, said: ‘They haven’t addressed the large number of concerns about whether such long and complicated guidance could ever be implemented by GPs in everyday clinical practice.’
The guidelines development group also faced criticism for not recommending GPs consider risk factors alongside symptoms in weighing up the patient’s risk of cancer.
Dr Nick Summerton, former NICE advisor and a GP in East Yorkshire, said it was ‘bonkers’ to ignore risk factors.
Dr Summerton said: ‘To ignore risk factors is - to be kind to them – bonkers. When any person arrives in the surgery they have a baseline risk of cancer – prior probability – according to features such as age, gender, ethnicity, family history, lifestyle – for example, smoking – and co-morbidities.
‘We then collect other information on, perhaps, symptoms to enhance this probability. Thus to ignore baseline risk will mean increased referral of those at low risk and reduced referral of those at high risk - given the same symptoms. This is frankly stupid.’
However, Professor Hamilton said the addition of risk factors such as family history or smoking should not change the decision on whether a patient was investigated as the symptoms alone should be enough.
Other recent news items:
- Doctors’ union finally agrees to spread the word
- Disability Politics UK: call to prioritise step free access
- Children with disabilities: targeted violence and hostility
- Dementia care: how social enterprises are developing products and services
- Adass spring seminar: four things you need to know
- The Disability Audit: the eight coalition policies that have hit disabled people
- DWP told to publish ESA deaths report, after two-year delay
- The struggle to find work when you have Down's syndrome
- PIP Delay Crisis Over, Claims DWP
- Meet Justin Tomlinson MP- New Minister For Disabled People
- A quick guide to new care minister Alistair Burt
- How to use your disability as a strength when applying for jobs
- Devastating impact of cuts on disabled people
- NHS ‘has wasted more than a year’ on latest bid to improve wheelchair services
- Five Thousand Disabled Adults Sexually Abused In Last 2 Years Says NSPCC
- ESA Claimant Takes On Maximus And Wins
- One in five benefit-related deaths involved sanctions, admits DWP
- Manchester United tell family with disabled son to watch Stockport instead
- Joint mental health commissioning strategy
- New parliament sees number of disabled MPs plunge
- Motability under spotlight over cuts to grants… despite £190 million reserves
- Disabled people ‘should come together in new national body’
- 'It's a great honour': Selby appoints UK's first mayor with learning disabilities
- Voluntary Community Social Enterprise Review website
- Cameron downgrades minister for disabled people
- Poor UK cancer survival rates linked to lack of GP direct access to scans
- Charity highlights role of siblings in supporting adults with a disability
- Queen’s Speech fails to mention social care funding
- Queen’s speech ‘suggests the worst is yet to come'
- TV industry must improve representation of disabled people
- The bionic suit helping wheelchair users get back on their feet
- New project to tackle mental health issues
- Equality watchdog contradicts football’s Premier League over access
- Schools 'must improve support for diabetic children'
- National Theatre plans shows on issue of disability
- Rise in mental health bed occupancy
- Watchdog writes to Man Utd after stewards confiscate walking aids from fans
- Government cuts ‘could see disabled people slide back to the bad old days’
- Disabled payment delay unlawful, judge rules
- The 'dragons' who want to help disabled people start their own business
- Boy, 12, wins £120,000 in damages after swine-flu jab left him 'severely disabled' by narcolepsy
- DWP ignores watchdog’s deadline over benefit-related deaths
- Man who cannot walk or talk called for jobcentre 'back to work' interview
- UK woman can ride bike for first time with 'world's most lifelike bionic hand'
- GPs to refer more patients with low-risk cancer symptoms under new NICE guidance
- Disability campaigners clash with police inside parliament over benefit cuts
- Indefinite Award DLA Transfer To PIP Will Start From July In Certain Postcodes
- Disabled children less happy with hospital care than peers
- ILF closure: Process has caused ‘fear, stress and anxiety’, say researchers
- Disability poverty rose sharply in fourth year of coalition
- UK services failing patients with dementia
- Shadow disability minister admits backing assisted suicide bill
- Disabled people's rights threatened by government cuts, campaigners warn
- BBC Three’s ‘Defying The Label’ Season
- From 'bloodied knees' to the House of Commons as a disabled MP
- Mental health patients sent hundreds of miles for beds as out of area placements rise 23 per cent
- Systematic over-medication blights learning disability care
- The Superhumans return to Channel 4
- Accessible Information Standard Approved
- Doctors demand return of lung cancer awareness campaign
- David O’Mar, 58, Found Fit For Work Two Weeks Before His Death
- World First Bionic Eye Gives Hope To Millions
- Seven-day NHS to include child mental health services, minister confirms
- Court hears appeal on ‘unfair’ PIP 20 metre rule consultation
- New report by Business Disability Forum cites lack of skills in line managers as major barrier to retention of disabled employees
- Tanni says 10,000 signatures could finally transform wheelchair services
- BBC3 presenter and journalist crowdfunding to transform the lives of people with disabilities in Ghana
- Disabled voters take pioneering legal action over election access
- Has disability sport lost its London 2012 Paralympics momentum?
- NHS Announce New Care Guidelines For Learning Disabilities
- Fresh evidence that ‘benefit scrounger rhetoric’ is causing hate crime
- Sanctioned Jobseekers With Mental Health Problems Are Not ‘Vulnerable’ Says DWP
- Clubs “Neglecting Responsibility” To Disabled Fans
- Latest Figures Show Massive Rise In ESA Sanctions
- ‘Bizarre’ figures raise fears over ministers’ plans for ESA
- School nurses ‘need better mental health training’
- Number of people developing dementia 'stabilising'
- Boy, nine, fitted with first prosthetic hand that can change grip with gestures
- Iain Duncan Smith criticises employers over disability employment gap
- Disability benefit sanctions soar by 30% in a year
- Thousands have died after being found fit for work, DWP figures show
- Goths at risk of depression or self-harming, research says
- Elderly 'ripped off' in mobility scooter market
- GPs are missing cancer in children - because they 'don't have enough training'
- IDS announces 'fitness for work' U-turn that was five years in the making
- People with autism and learning disabilities excel in creative thinking, study shows
- Starbucks apologises for telling woman she was not 'disabled enough' to use the toilet
- DLA Lifetime Award PIP Transition Started from 1 September in 29 New Areas
- Successful 'Fit for Work' Appeals at Highest Ever Level, Show DWP Stats
- Why is our justice system failing vulnerable people?
- UN investigating British Government over human rights abuses caused by IDS welfare reforms
- Coroners 'ground breaking' verdict: Suicide was 'triggered' by 'fit for work' test
- Schoolboy calls for more disabled characters in children's books
- The quadruple amputee who needs the correct prosthetic
- Welfare to work programme failing disabled and ill jobseekers, say charities
- Disabled fans 'delighted' as Premier League finally acts on access
- Two-thirds of adult social care requests rejected by local councils
- Independent Living Fund: Government silence 'suggests something to hide'
- UK employers report rise in mental health problems: CIPD study
- UN inquiry considers alleged UK disability rights violations
- Parliament's own disability group picks first non-disabled chair in nearly 50 years
- Dementia drug 'keeps patients out of nursing homes'
- Disability benefit cuts will actually make it harder for disabled people to find work,coalition of 60 charities warns
- Problems with the care and treatment provided by the NHS and/or difficulties in accessing health services?
- Consultation on the proposed new adult social care strategy
- The Leicestershire Advice Service for Social Care is here to guide you
- Minister: MPs must help 'open doors' for disabled jobseekers
- 'Homes not hospitals': learning disability care to move to community
- Equality Act 'simply isn't strong enough' for BSL-users, peers are told
- Disability Hate Crimes Rise 41% In A Year
- Companies fear employing people with learning disabilities, survey reveals
- DWP cuts specialist disability employment advisors in jobcentres by over 60 per cent
- Watchdog 'must do more to support disabled people to fight discrimination'
- ‘We must keep banging the drum,’ says bus campaigner after five-year fight for justice
- 2,000 disabled people wrongly declared ‘fit to work’ by DWP in just three months
- Local authorities 'spend close to nothing on mental health'
- Rock band with learning disabilities release first single
- NICE seeks to improve diagnosis and treatment of cerebral palsy
- Premier League clubs face legal threat unless disabled access is improved
- UK’s progress on disability rights ‘patchy and tortuous’, UN told
- Peer pressure sees minister finally announce date for taxi access laws
- Stop the NHS slashing vulnerable people’s care packages in and around Leicestershire
- Minister tells industries to increase representation of disabled people
- Disabled children in England 'finding it increasingly hard to access council care'
- Wheelchair Rugby Loses Funding Appeal
- Plans that could force people into institutions could be ‘front line’ of national problem
- Young people 'fear stigma' if they ask for mental-health help
- Disability benefits process is 'inherently flawed', MPs told
- Businesses woefully ill-equipped to deal with Britain's rapidly growing mental health crisis
- Cash boost for pupils with special needs and disability
- PIP investigation: ‘Horrific’ suicide question sparks fresh assessment inquiry calls
- Disability report: Being disabled in Britain
- Stop PIP reassessments for patients with progressive diseases, campaigners say
- Patients with learning disabilities missing out on health checks
- Thousands have disability vehicles taken away
- Aspire announces GLL and LCiL as first partners to lead InstructAbility
- Easy read guide to voting by post
- Online campaign ‘could enable disabled people to affect election outcome’
- Health Committee inquiry and report: Brexit and Health and Social Care – People and Process
- Women’s Resource Centre report: the Impact of Austerity Measures on Women’s Voluntary and Community Organisations
- Disabled people ‘forced into dangerous workfare that breaches health and safety laws’
- Mental Health Foundation report: Surviving or Thriving? The State of the UK’s Mental Health
- Stirling University to launch home dementia app
- General Election 2017: What are the parties promising disabled people?
- Anger, resignation… and optimism in wake of general election result
- New disabled MPs pledge to fight for rights in parliament
- Queen’s speech: May ‘abandons’ election pledge on access
- The waiting time for a vital disability benefit has risen hugely in 6 months
- Almost 6,000 mental health patients sent out of area for care last year
- Patients increasingly forced to crowdfund their own wheelchairs as NHS provision not enough, doctors warn
- Years of austerity have left personal assistance in ‘very fragile state’
- Over Half Of Foodbank Users Are Households With A Disabled Person
- Prince Harry launches brain injury card in Suffolk
- Iain Duncan Smith says work capability assessments don't work and are 'too harsh'
- PIP investigation: 200 cases of dishonesty… and still DWP, Atos and Capita refuse to act
- Global blindness set to 'triple by 2050'
- My disability abortion bill could halt Britain’s slide towards eugenics, says Tory peer
- Jobcentre Staff Have An Alarming Lack Of Confidence Dealing With Disabled Claimants
- BBC initiative for disabled actors is a ‘wake-up call’ for producers