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.”
Gaps in how systems were being implemented were also found.
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.”
A spokesperson for NHS England said: “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.”
The HSSIB report followed a survey of ۷۱۲ GPs by Pulse that found about a quarter of patient referrals are being rejected and returned as unsolicited A+G.
Family doctors also estimated that ۳۶% of the A+G they received asked them to do work considered outside their remit, and others raised concerns that the process is creating waits for people with suspected cancer.
Dr Clare Bannon, the GPs’ committee chair at the British Medical Association, said: “Since its introduction, GPs have expressed deep concern with the advice and guidance system – we know our patients and know when a referral needs to be made. So this report is tragic vindication for these concerns, now showing that patients have come to harm as a result of this rushed-out and inconsistently applied process.
“Just this week we had GPs telling a survey that a quarter of referrals were being sent back as advice and guidance, while genuine advice and guidance requests were taking ۱۰ days or more for a response.
“We know the pressures our colleagues in secondary care are facing and it’s clear that this process is not working for either of us, nor our patients.
“The HSSIB is right to recommend an urgent evaluation of the advice and guidance system to address these clear patient safety risks.”
