An article by Dr Amy Glossop, Clinical Editor, Map of Medicine
An adaptation of this article was originally published in the RCGP Clinical Newsletter, Issue 205.
Early diagnosis of cancer has been identified by the Department of Health as being key in improving cancer outcomes, particularly as outcomes in England are poor in comparison with the best in Europe¹. In June 2015, NICE published new referral guidance for suspected cancer². This has extensively updated and replaced their 2005 guideline, which had formed the basis of the criteria used for urgent ‘two-week wait’ referrals. This has resulted in some significant changes to the suspected cancer pathways developed by Map of Medicine.
The new guideline aims to improve early detection of cancer in the UK by using a ‘risk threshold’ for referral for patients with a symptom or combination of symptoms where there is a risk of cancer of 3%. Guidance has not only been sorted by cancer site but also by symptom, recognising that some symptoms may be common to multiple different cancers ². Further recommendations have also been introduced on the use of direct-access tests in primary care so that GPs can refer directly for an investigation that may have previously been restricted to secondary care thereby reducing delay further. At present, access to certain direct-access tests such as brain MRI is very variable across the NHS¹.
Clinical Commissioning Groups (CCGs) have a challenge to raise awareness of these extensive changes to the criteria, as well as ensuring that specialist services are in place to allow the guidance to be implemented. Map of Medicine is used by CCGs to provide best-evidence, locally customised pathways, and referral guidance to support decision management and improve referral quality.
Map of Medicine has updated all affected clinical referral guidance and care pathways in Map Pathways and Map Referrals to ensure that recommendations are in line with new guidelines. This ensures that CCGs are able to access the most up to date evidence-based national recommendations to enable them to implement the guidance across their health community and support their local GPs.
¹Department of Health. Improving Outcomes: A Strategy for Cancer. January 2011
²National Collaborating Centre for Cancer. Suspected cancer: recognition and referral. NICE CG27. June 2015