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This initiative, announced by the NHS England Chief Executive, is part of the drive to diagnose cancers earlier in the NHS by “fast-tracking” community-based diagnostic testing.

A key aim of the NHS Long Term Plan is to increase the proportion of cancers diagnosed at an early stage to 3 in 4 by 2028. Two of the proposed mechanisms to achieve this goal are to lower the threshold of referral by GPs and to accelerate access to diagnostic tests.

NHS England Chief Executive, Amanda Pritchard, has this week announced that all GPs in England will soon be able to order cancer tests for their patients directly. It is hoped that this initiative will result in thousands of people having their cancers detected earlier every year.

Under the current system, GPs refer patients with symptoms of suspected cancer to specialised cancer diagnostic pathways in secondary care. The hospital doctors then order tests to investigate the symptoms and diagnose cancer if it is present.

Dr Brian Nicholson (academic GP, Nuffield Department of Primary Care Health Sciences) commented: “Existing urgent referral pathways are very effective for cancers that have a clear pattern of associated symptoms, such as breast lumps for breast cancer. However, for people with cancers associated with non-specific symptoms, such as abdominal pain or weight loss, the pathway to a diagnosis is not as clear and there is still a wide variation across the country in the tests that GPs can easily request.

I welcome the announcement that GPs will have greater access to CT scans, ultrasounds, and brain MRIs to identify patients who require further cancer investigation. This has great potential to reduce the time taken to reach a cancer diagnosis and to allow patients to be investigated closer to home in the community. However, after a test is performed, a report is written that outlines the test results and gives recommendations for next steps in the patient’s care. Increasing the number of tests performed must be matched with an increase in the capacity of the specialist radiologist workforce who are able to make clear recommendations for GPs to act upon.”    

This announcement builds on the development of vague symptoms pathways in the NHS, such as the work led by Oxford researchers that has already accelerated the diagnosis of cancer in patients with non-specific symptoms. In 2017, Dr Brian Nicholson and Professor Fergus Gleeson designed the Suspected CANcer (SCAN) pathway in Oxfordshire. This pathway allows GPs to refer patients with non-specific symptoms for whole body imaging and a range of blood tests to investigate for cancer. This has saved many NHS appointments. The time to diagnosis is shorter, reducing patient anxiety and the number of tests. SCAN directly informed the specification of the NHS’s new Rapid Diagnostic Centres being rolled out in England and the development of the Welsh Single Cancer Pathway, accelerating diagnoses for patients nationally.