Safety netting

What is safety netting and why is it important?
Safety netting is a diagnostic 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:
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Support patients with non-specific or low-risk symptoms by providing clear information and arranging time-bound follow-up
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Ensure patients complete investigations and attend referrals
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Monitor persistent symptoms even after negative test results
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 using e-safety netting tools. Whichever format the safety netting takes, the key principles remain the same – as summarised below.
Clear communication |
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Give clear, specific advice: avoid vague phrases and include specific details of when, how and why someone should seek help, timescales for symptoms to resolve, when to seek further help and who to contact.
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Use accessible language: use simple terms, avoid jargon and ensure the patient can understand and recall the advice. Make use of accessible and translated information where appropriate.
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Provide written information: offer patients leaflets or written summaries of advice to refer back to.
Shared decision making |
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Confirm understanding: verify the patient’s understanding of the advice and why it’s important to follow.
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Address concerns: acknowledge and address the patient’s expectations and concerns about their symptoms or investigations.
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Agree next steps: Agree specific follow-up actions and provide instructions on how to access advice if needed.
Through documentation |
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Document advice given: record safety-netting advice provided in patients’ notes, ensuring it’s clear and comprehensive.
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Code actions: code symptoms, diagnostic tests and referrals in your system appropriately so they can be identified and tracked.
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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
National safety netting guidance
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.
Safety netting and addressing inequalities
It’s important to be aware of groups of people who are more likely to experience poorer outcomes and could benefit from more active or targeted safety netting. These groups include:
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People with non-specific symptoms of cancers that are more likely to experience multiple (≥3) consultations prior to referral such as sarcoma, bone, upper GI, brain, small intestine, hepatobiliary, cancer of unknown primary, oropharyngeal/oral, anal or penile cancers [1,2].
These people should be advised to re-present until their symptoms are explained or resolved.
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People who’ve been diagnosed or given medication which might explain their symptoms long term. For example, reflux in cases of oesophageal cancer [3,4], women presenting with a UTI in cases of bladder cancer [5,6] and exacerbation of COPD in cases of lung cancer [7].
These people should be advised to re-present if they have persistent or exacerbating symptoms.
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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 condition [8].
These people should be encouraged to re-present if they feel their health is not returning to normal within a defined timeframe.
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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 test [9], 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 attended tests 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:
Are there nominated clinical and administrative leads for safety netting who can champion best practice and educate on processes? |
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Do you have electronic safety netting tools in place? | |
Are the tool(s) adopted practice-wide, with all staff trained to use the system? | |
Are clear instructions on safety netting systems and protocols included in induction packs for new employees and for locum GPs? |
For health professionals
Are there clear protocols in place to address specific situations flagged by the electronic safety netting system? For example, the use of templates for onward referrals to secondary care? Refer to the electronic safety netting toolkit (for EMIS web users) for more guidance. |
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Are there agreed timeframes for running searches on trackable events for example completion of diagnostic tests like FIT - and an accountable person/people to do this? | |
Are you using standardised SNOMED codes for Safety Netting to record safety netting actions and track patient progress? For practices in England. You can explore your PCN’s use of the official SNOMED codes for Safety Netting compared to other PCNs, using the PCN dashboard. |
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Do you conduct regular reviews of delayed or missed cancer diagnoses? These can be used to identify where safety netting practices can be improved, and it’s useful to structure them using a framework for example a Significant Event Analysis. |
Additional resources to support safety netting:
References
1. 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.
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.
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.
7. Mitchinson L, al. Clinical decision-making on lung cancer investigations in primary care: a vignette study. BMJ Open. 2024.
8. Whitelock, V. Cancer Research UK’s 2024 Cancer Awareness Measure ‘Plus’ (CAM+). 2024.
9. 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.