Safety netting

Find out how electronic systems and their functionality can support you with safety netting best practice: Guidance on e-safety netting tools

Read our safety netting case study of how John’s journey to a cancer diagnosis is impacted by safety netting.

What is safety netting and why is it important?

Safety netting is a diagnostic and referral management strategy that ensures patients - especially those with potential signs and symptoms of cancer - are monitored throughout the diagnostic process until symptoms are explained or resolved, and all results have been acted on.

It plays a vital role in helping primary care professionals manage diagnostic uncertainty. For example, safety netting can be used to:

• Support patients with non-specific or low-risk symptoms by providing clear information and arranging time-bound follow-up

• Ensure patients complete investigations and attend referrals

• Monitor persistent symptoms, even after negative test results

Download our safety netting flowchart(PDF, 154 KB) to see where safety netting practices can be applied in the primary care pathway to help manage the above.

We know that safety netting is often already part of everyday practice for GPs and primary care teams. The information, tools and resources here aim to support practices to strengthen and streamline their approach - improving clarity, communication, and continuity of care.

Key principles for effective safety netting

Safety netting in primary care can take many different formats, including verbal advice, written instructions or physical resources and the use of e-safety netting tools. Whichever format the safety netting takes, the key principles remain the same - as summarised below.

Clear communication

• Give specific advice, including when, how and why to seek help, expected symptom timelines, and who to contact.

• Use simple, accessible language and translated materials where needed.

• Provide patients with written summaries or leaflets.

• When referring, explain your reasoning (including ruling out cancer), what tests involve, why timely attendance matters, and how results will be shared. Use our ‘Your urgent referral explained’ leaflet to support conversations.

Shared decision making

• Confirm understanding: verify the patient’s understanding of the advice and why it’s important to follow.

• Address concerns: acknowledge and address the patient’s expectations and concerns about their symptoms or investigations.

• Agree next steps: agree specific follow-up actions and provide instructions on how to access advice if needed.

Through documentation

• Document advice given: record safety-netting advice provided in patients’ notes, ensuring it’s clear and comprehensive.

• Code actions: code symptoms, diagnostic tests and referrals in your system appropriately so they can be identified and tracked.

• Harness e-safety netting tools: leverage clinical IT system functions like templates and alerts, to ensure follow up actions are completed. Learn more about e-safety netting tools.

Download our safety netting flowchart(PDF, 154 KB) to see where these key principles can be applied in the primary care pathway to help manage patients.

National safety netting guidance

NICE NG12 guidelines for suspected cancer recognition and referral (2023)

Scottish Cancer Referral Guidelines for Suspected Cancer (2025)

While the Northern Ireland Cancer Network (NICaN) provide primary care guidance for GPs practicing in Northern Ireland, specific safety netting advice is not included. As safety netting is an important component of timely referral and management of suspected cancer, all information provided on this page is applicable UK-wide.

Visit our suspected cancer referral guidelines webpages for resources to support you with navigating referral guidance.

Safety netting and addressing inequalities

It’s important to be aware of the types of presentations and groups of people who are more likely to experience poorer outcomes and could benefit from more active or targeted safety netting. These include:

• People with non-specific symptoms of cancers that are more likely to experience multiple (≥3) consultations prior to referral. These cancers include sarcoma, bone, upper GI, brain, small intestine, hepatobiliary, cancer of unknown primary, oropharyngeal/oral, anal or penile cancers¹

  Ozawa M, et al. Symptoms in primary care with time to diagnosis of brain tumours. Family Practice. 2018.

  , ²
  Mendonca SC, Abel GA, Lyratzopoulos G. Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data. British Journal of General Practice. 2016.

  .

These people should be advised to re-present until their symptoms are explained or resolved. If a patient presents three times with the same symptoms or concerns, particularly if symptoms unexpectedly persist, escalate, or remain unexplained, reflect and consider reassessing the diagnosis (known as Jess’s rule in England). Visit our managing non-specific symptoms page for more support around referral guidance and pathways across the UK.

• People who’ve been diagnosed or given medication which might explain their symptoms long term. For example, reflux in cases of oesophageal cancer ³

  Hardy V, et al. Agreement between patient’s description of abdominal symptoms of possible upper gastrointestinal cancer and general practitioner consultation notes: a qualitative analysis of video-recorded UK primary care consultation data. BMJ Open. 2023.

  , ⁴
  Humphrys E, et al. Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study. BJGP Open. 2020.

  , women presenting with a UTI in cases of bladder cancer ⁵
  Y, et al. Improving the diagnostic process for patients with possible bladder and kidney cancer: a mixed-methods study to identify potential missed diagnostic opportunities. British Journal of General Practice. 2023.

  , ⁶
  Zhou Y, Walter FM, Singh H, Hamilton W, Abel GA, Lyratzopoulos G. Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study. Cancers. 2021

  and exacerbation of COPD in cases of lung cancer ⁷
  Mitchinson L, al. Clinical decision-making on lung cancer investigations in primary care: a vignette study. BMJ Open. 2024.

  .

These people should be advised to re-present if they have persistent or exacerbating symptoms.

• People who are infrequent attenders or you feel are less likely to re-present after initial presentation. This may include middle aged and older people (aged 30-49, and 50+ years) and people without a disability or mental health condition⁸

  Whitelock, V., (2024). Cancer Research UK’s 2024 Cancer Awareness Measure ‘Plus’ (CAM+).

  .

These people should be encouraged to re-present if they feel their health is not returning to normal within a defined timeframe.

• People who are less likely to engage with referral tests or investigations. For example, men, those under 65-years-old, people from ethnic minority groups and more deprived areas are less likely to return a FIT test⁹

  Bailey JA, et al. Sociodemographic variations in the uptake of faecal immunochemical tests in primary care: a retrospective study. British Journal of General Practice. 2023.

  , potentially leading to longer time to a cancer diagnosis.

These people should be monitored, potentially using e-safety netting tools, to check whether they have engaged with the next steps and provided with active facilitation or encouragement.

Reviewing and optimising your safety netting processes

Use the below checklist to review and optimise safety netting processes in your practice.

For practice managers or system leaders:

For clinicians

Resources to support safety netting

• Safety netting flowchart(PDF, 154 KB)

• Safety netting for FIT negative patients

• Safety netting for suspected lung cancer patients

• Managing non-specific symptoms

• Macmillan’s safety netting in primary care consultations

• Macmillan Learning Event Analysis (LEA) toolkit for early diagnosis of cancer