GPs’ advice service is causing cancer diagnoses to be missed, inquiry finds

Advice and guidance services for doctors in England found to be creating risk of missed or late detection of illness

Cancer diagnoses have been missed or delayed because of a system designed for GPs to seek specialist advice before referring patients to hospital, according to an investigation.

The Health Services Safety Investigations Body (HSSIB) identified patient risks linked to how advice and guidance (A+G) services have been implemented across England .

A+G was brought in to slash unnecessary hospital visits and reduce waiting times, allowing family doctors to seek specialist input before making referrals.

The service has “positively influenced patient care” by improving communication between GPs and consultants, and “enabled efficient specialist input into care”, the HSSIB said.

However, the investigation found evidence that A+G had “contributed to near misses and incidents of patient harm, both physical and psychological” where it had been poorly implemented or monitored.

The report said “harm had arisen as a result of delayed or missed diagnoses, and delays to care and treatment”.

It added: “Evidence demonstrated that A+G services were being used in some pathways where general practice had requested specialist assessment for suspected cancer.

“Incidents demonstrated that this had contributed to delays in diagnosis.”

For example, some local pathways required GPs to use A+G instead of making direct referrals, or referrals were rejected despite persistent concerns from family doctors.

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 the HSSIB, said: “A+G services are making a real difference for patients in many parts of the NHS , and we heard genuine enthusiasm for what they can achieve.

“But we also heard serious concerns, and found evidence of harm where implementation has not been adequately designed or monitored.

“Our recommendations are about ensuring that expansion happens safely with the right support, standardisation and oversight in place to ensure patient safety is a priority.”