NHS trusts allow patients to self-refer for chest x-rays in case of GP appointment crisis

The NHS is piloting self-referrals for lung cancer checks to reduce diagnostic delays caused by a GP appointment crunch.

Hospitals in Greater Manchester, Leeds and Leicestershire are trialling the initiative to make it easier for people to find out whether or not they have lung cancer.

Lung cancer is one of the leading causes of death in the UK and the deadliest cancer – killing around 35,000 people a year.

Early detection and treatment are essential to improve survival rates.

Doctors are now calling for the scheme to be rolled out across the UK so patients can have themselves examined without having to visit the GP before they can access a scan.

An analysis published in the British Journal of General Practice found that the number of lung cancer cases detected by self-referral was similar to that of a GP.

Initial results from the Manchester pilot revealed that around 2 per cent of patients had cancer, while 95 per cent had a normal scan. The others had another significant but non-cancerous lung problem that required follow-up.

Currently, patients must get an appointment with a family doctor and a referral for an urgent cancer test, then wait for the results, which can take weeks or even months.

There are around 500 fewer full-time GPs than there were five years ago, while the patient list continues to grow.

In November, one in five GP appointments took place at least two weeks after booking, this includes patients booking follow-up in advance.

Some 43 percent were delivered the same day and less than two-thirds of the total were face-to-face.

With the walk-in chest x-ray service, patients can come in without an appointment and get results as soon as one week.

The on-demand chest x-ray service was rolled out in Leicestershire last month following success in other parts of England.

Under the scheme, patients with symptoms such as persistent cough, fatigue and difficulty breathing can access radiology services directly, with their x-ray report sent to their GP.

Patients must be aged 40 or over, not have had an X-ray in the previous three months and be registered with a GP in the relevant region.

Experts have said more people with lung cancer symptoms in the UK should be able to refer themselves for tests rather than waiting for their GP to order them.

The analysis by academics, doctors and the Roy Castle Lung Cancer Foundation called for the rollout of self-referral services without GP consultation across the country.

They said this “merits urgent consideration” given the “current difficulties patients face in accessing primary care”.

Dr Stephen Bradley, lead author of the analysis and a practicing GP in Leeds, said: “A diagnosis of lung cancer can be devastating, but catching it early can make all the difference.

“We have made a lot of progress, but there is still much to be done to diagnose the problem as quickly as possible. »

Previous studies by the same doctor found that around 1.2 percent of patients referred for an x-ray by their GP were diagnosed with lung cancer within a year, although only around 75 to 80 percent x-rays correctly identify the disease.

Some patients waited more than 200 days for a false negative result and were subsequently diagnosed with cancer.

Among other recommendations, experts said data on the number of chest X-rays ordered each year by GPs should be made available to highlight areas where patients can benefit.

Dr Bradley added: “We need to make it easier for people with symptoms to have tests like chest X-rays and find ways to raise awareness of the disease, including people who have not smoked.

“We hope that the UK health service will take these recommendations seriously and help us to give people with lung cancer the best possible chance.”

Nick Whitehead, 58, from Newton Aycliffe, visited his GP several times with a persistent cough over the course of around 18 months, but was never sent for a chest X-ray.

He was eventually diagnosed with lung cancer two years later, during a visit to the emergency room after coughing up blood.

“I had many opportunities to be diagnosed earlier,” Mr Whitehead said. “I think I wasn’t sent for the tests because I was too fit.

“As a diver, my lung capacity is good, so I was not out of breath, but given that we are constantly told that a persistent cough is a symptom of lung cancer, it is strange that I am not do not consult. x-ray at a minimum.

“If I had had the opportunity to ask for an X-ray, I would have let it happen. My wife would have made sure of it.

According to the NHS, more than 43,000 people are diagnosed with lung cancer in the UK each year. Smoking is the most common cause, accounting for about 70 percent of cases.

In 2019, the health service launched a targeted lung health monitoring program and has since detected 5,037 lung cancers, according to the latest data.

The program uses a combination of hospital services and roving scanning trucks in community hotspots like supermarket car parks.

Data shows that more than three-quarters of lung cancers identified were stage one or two, which are easier to treat, and that patients are almost 20 times more likely to survive five years than those whose cancer is detected late.

“Imperative” change

Professor Sir Stephen Powis, national medical director of the NHS, said: “The NHS recognizes the importance of early and accurate diagnosis of respiratory diseases. That’s why we invite more than a million people to a lung cancer check at convenient locations across the country, while basic lung function tests are available at GP practices and centers community diagnostics.

In June 2023, it was announced that a targeted lung cancer screening program would be rolled out and available across England by 2029 for people aged 55 to 74 who have smoked.

Paula Chadwick, chief executive of the Roy Castle Lung Cancer Foundation, said: “All too often we hear stories of people like Nick whose lung cancer could have been diagnosed earlier. It is imperative that we do everything we can to change this.

“We are making progress, largely due to screening, with 76% of people detected at stages one and two.

“However, with more than half of lung cancers occurring in people who are not eligible for screening and only about half of those who are eligible choose to participate, improving early detection among people with symptoms is essential to transform long-term survival.”

A Department of Health and Social Care spokesperson said: “As part of this Government’s plan for change to radically reform the NHS, we will tackle cancer on all fronts – through prevention, diagnosis , treatment and research.

“We are committed to transforming diagnostic services, particularly for lung diseases, so that we can detect more cases earlier and treat them faster. We will also offer 40,000 more elective care appointments every week and invest a further £1.5 billion in new surgical centers and AI scanners.

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