Safety netting

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: 

• 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 

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. 

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. 

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

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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. 

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:  

• 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.  

• 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. 

• 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. 

• 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. 

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?
• 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
• 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.
• 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.