Cancer diagnoses have been missed or delayed due to a system intended for GPs to seek specialist advice before referring patients to hospital, an investigation has revealed.
The Health Services Safety Investigations Body (HSSIB) identified patient risks associated with how advice and guidance (A+G) services have been implemented across England. While A+G was introduced to reduce unnecessary hospital visits and waiting times, the investigation found evidence of harm where implementation was inadequate.
The report stated that harm had arisen from delayed or missed diagnoses, and delays to care and treatment. It noted that A+G services were being used in some pathways where general practice had requested specialist assessment for suspected cancer, contributing to diagnosis delays.
Gaps in system implementation were also identified, including local pathways requiring A+G instead of direct referrals, or referrals being rejected despite GP concerns. The HSSIB has 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.
NHS England acknowledged that A+G has positively influenced patient care but stated that more needs to be done for it to work effectively. They are providing guidance and tools to GPs and hospitals and have commissioned an evaluation of its impact, set for publication this year.