GP advice system blamed for missed cancer diagnoses

A system designed to help general practitioners (GPs) seek specialist advice before referring patients to hospitals has inadvertently led to missed or delayed cancer diagnoses, according to an investigation by the Health Services Safety Investigations Body (HSSIB).

The Advice and Guidance (A+G) service was introduced across England to streamline patient care, aiming to reduce unnecessary hospital visits and shorten waiting times by enabling GPs to consult specialists. The HSSIB report acknowledged that A+G has "positively influenced patient care" by enhancing communication between GPs and consultants and facilitating "efficient specialist input."

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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.

However, the investigation uncovered evidence that the A+G service has "contributed to near misses and incidents of patient harm, both physical and psychological" in instances where it was poorly implemented or monitored. The report detailed how "harm had arisen as a result of delayed or missed diagnoses, and delays to care and treatment," particularly in suspected cancer cases where GPs were required to use A+G instead of making direct referrals, or where referrals were rejected despite persistent concerns.

In response, the HSSIB recommended that NHS England and the Department of Health and Social Care urgently evaluate A+G services to address deficiencies in resources, capacity, training, and patient safety incident reporting. Dr. Nick Woodier, a senior safety investigator, emphasized the need for "support, standardisation and oversight" to ensure patient safety as the service expands. NHS England confirmed that efforts are underway to provide GPs and hospitals with better guidance and tools, and an evaluation of the service's impact is expected later this year.

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As HSSIB acknowledges, advice and guidance has positively influenced patient care by reducing waiting times and giving people quicker access to specialist advice, but we know more needs to be done to make it work even more effectively. That is why we’re giving GPs and hospitals clear guidance and practical tools to help deliver the service safely, consistently and effectively across the NHS, and have already commissioned an evaluation of its impact which will be published this year.