Suspected Cancer Referral Guidelines

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Health Professional COVID-19 and Cancer Hub

About the NICE referral guidelines

What do the guidelines cover?

The NICE guidelines make recommendations on how to manage children, young people and adults with potential cancer symptoms that present to primary care. They set out;

Potential cancer signs and symptoms;
Recommendations on the appropriate diagnostic tests for patients;
How soon diagnostic tests or a consultation should be carried out depending on the signs and symptoms (e.g. within 48 hours, 2 weeks etc);
Recommendations for ‘safety netting’ patients;
Recommendations on the information and support to provide to people with suspected cancer and their families and/or carers.

Read the 2015 NICE referral guidelines for suspected cancer

What are the major changes?

The updated NICE guidelines include a number of changes aiming to give GPs more flexibility to refer patients in order to help diagnose cancers earlier;

Symptom thresholds lowered; any that have a three in 100 chance (or more) of being caused by cancer are now included;
For children and young adults, that threshold has been lowered even further;
Guidance organised by signs and symptoms is now available, a format that much better reflects how patients present to primary care;
GPs recommended to refer patients directly for tests, such as CT scans and endoscopies, for a number of symptoms. This should support more comprehensive rollout of direct access nationally;
“Very urgent” referrals now recommended for some symptoms, where a patient should be seen within 48 hours;
Specific recommendations on safety netting patients are now included.

Impact of changing the guidelines

What impacts will the changes have?

NICE estimate that the guideline changes will lead to a significant increase in referrals, which will have cost implications. However, it’s also likely that there will be wider benefits to patients and the NHS, such as reduced emergency presentations and lower treatment costs for patients diagnosed earlier.

There is already considerable financial pressure on NHS services and with the number of people diagnosed with cancer increasing – further investment is essential in order to support this much needed shift in investigative testing.

NICE have produced a number of resources to help local teams assess the impact of the guidelines on services.

Likely benefits of the updated guidance

NICE outline a number of benefits that the changes to the referral guidelines, in particular lower referral thresholds, may bring to both patients and NHS services;

Earlier diagnosis of cancer, leading to increased survival;
A reduction in cancers diagnosed via an emergency route;
Optimised diagnostic processes;
More appropriate referrals to secondary care for suspected cancer.

Dr Richard Roope, a practising GP and clinical lead for cancer at Cancer Research UK and the Royal College of General Practice, shared his thoughts on the potential benefits of the new guidelines.

Read Dr Roope's blog: “New NICE GP guidelines have huge ambition and potential”

Impacts on suspected cancer referrals

NICE’s costing team worked with the Guideline Development Group and other professionals to estimate which recommendations in the updated guidelines would have the most significant impact on referrals and tests for suspected cancer.

The tumour groups for which a significant resource impact is estimated are:

lung and pleural cancers
upper gastrointestinal tract cancer
lower gastrointestinal tract cancer.

Suspected cancer pathway referrals for these tumour groups equate to 30% of suspected cancer pathway referrals for 2013/14. For other tumour groups NICE do not anticipate significant changes.

More information on the impacts of specific guidelines are detailed in a costing statement from NICE along with a wider assessment for bowel cancer highlighting the varying impacts of the guidelines on different NHS service.

Using the guidelines

Support for local implementation

NICE implementation assessment tools

NICE have produced a number of resources to help local teams understand and evaluate the impacts and costs of implementing the guidance.

NICE Implementation Roundtable – January 2016

Cancer Research UK brought together a team of health professionals from across the cancer pathway to reflect on the NICE suspected cancer recognition and referral guidelines and share their tips for local implementation.

See the write up 'Practical perspectives on implementing the NICE Guideline Suspected cancer: recognition and referral'

Cancer Research UK facilitators

Our facilitators are working with local teams in many parts of the country to support implementation of the guidelines.

Our facilitators work in partnership with NHS Commissioners, GP Cancer Leads, Public Health and other local bodies to provide support to GP practices.

Email us to find out if facilitators can support you

Summaries of the guidelines

Cancer Research UK interactive desk easel

We have produced an interactive desk easel for GPs, in conjunction with the Royal College of General Practitioners (RCGP),which summarises the NG12 guidelines. Designed as a pdf document, GPs can access the summary from their computer and click through to the recommendations for each symptom group. Recommendations for adults, children and young people are covered, as well as primary care investigations. There’s also some additional advice on diagnostic tests and safety netting.

Download the interactive desk easel

We will be distributing a limited number of hard copies to GPs via our facilitators – find out whether you have facilitators in your area.

If you have any feedback or comments about the easel please get in touch at earlydiagnosis@cancer.org.uk or fill in our online survey.

Cancer Research UK posters

We have developed three symptom-led summaries of the guidance with the help of Dr Richard Roope and the Royal College of General Practitioners (RCGP).

New versions were created in 2020. Please take all copies of the November 2015 and March 2016 posters (marked version 2) out of curculation and only use the 2020 (marked version 3) from now on.

Download the posters:

Infographic style – Symptoms are grouped according to organ system, with a key directing you to NICE’s recommendations.
Infographic style for Scotland - For GPs in Scotland summarising the Scottish referral guidelines for suspected cancer by organ system.

Or order physical copies of these poster resources, for free, from the CRUK publications website.

We are keen to hear your views on these resources. If you have any feedback, you can get in touch at earlydiagnosis@cancer.org.uk.

NICE

NICE have provided their guidance organised by cancer site and by symptom and findings of primary care investigations. They have also provided a pathway tool which is searchable by cancer site or symptom.

British Medical Journal (BMJ)

The BMJ have published two summaries of the guidance from W Hamilton, et al;

Suspected cancer (part 1—children and young adults): visual overview of updated NICE guidance
Suspected cancer (part 2—adults): reference tables from updated NICE guidance

Macmillan Cancer Support

Macmillan Cancer Support have produced an update to their “Rapid Referral Toolkit” summarising the recommendations in the guidelines.

Videos explaining key information

These short videos explain the key information from NICE referral guidelines for 5 cancer types to help GPs put them into practice.