Key facts
- An inquiry found that a system for GPs to seek specialist advice before referring patients has led to missed or delayed cancer diagnoses.
- The Health Services Safety Investigations Body (HSSIB) identified patient risks associated with the implementation of advice and guidance (A+G) services across England.
- The A+G service was intended to reduce hospital visits and waiting times by allowing GPs to consult specialists before referrals.
- The HSSIB report indicated that A+G services contributed to delayed diagnoses in cases where GPs requested specialist assessment for suspected cancer.
- Recommendations were made for NHS England and the Department of Health and Social Care to evaluate A+G services for resource gaps, training, and reporting weaknesses.
- A survey of GPs revealed that approximately 25% of patient referrals are being rejected and returned as unsolicited A+G.
Cancer diagnoses have been missed or delayed due to issues with a system designed for General Practitioners (GPs) to seek specialist advice before referring patients to hospitals, according to an investigation by the Health Services Safety Investigations Body (HSSIB). The A+G service was implemented across England to reduce unnecessary hospital visits and waiting times by allowing GPs to consult specialists before making referrals. While the HSSIB acknowledged that A+G services have positively influenced patient care in many areas, improving communication and enabling efficient specialist input, the investigation found evidence of patient harm where the system was poorly implemented or monitored. Specifically, the report detailed harm arising from delayed or missed diagnoses and subsequent delays to care and treatment. It highlighted instances where A+G services were used in pathways for suspected cancer referrals, contributing to diagnostic delays. Gaps in implementation were also noted, such as pathways requiring A+G instead of direct referrals, or rejection of referrals despite GPs' persistent concerns. In response, the HSSIB recommended that NHS England and the Department of Health and Social Care rapidly evaluate A+G services to address resource and capacity gaps, training needs, and weaknesses in reporting patient safety incidents. Dr. Nick Woodier, a senior safety investigator at HSSIB, emphasized the need for safe expansion with proper support, standardization, and oversight. NHS England acknowledged the positive impact of A+G services but stated that more work is needed for effectiveness. The organization is providing guidance and tools to GPs and hospitals and has commissioned an evaluation of the service's impact, expected to be published this year. A survey by Pulse of 712 GPs indicated that approximately 25% of patient referrals are being rejected and returned as unsolicited A+G. GPs also estimated that 36% of A+G requests fall outside their remit. Dr. Clare Bannon, chair of the GPs' committee at the British Medical Association, described the report as tragic vindication for GPs' concerns, noting that patients have suffered harm due to the rushed and inconsistent application of the A+G process.