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Innovations in Oncology & Imaging Q1 2024

Referral guidelines for GPs: game-changer in swift cancer diagnosis

Shot of a nurse standing by her patient's bedside
Shot of a nurse standing by her patient's bedside
iStock / Getty Images Plus / laflor

Dr Qaiser Malik

Medical Director, Membership and Business, the Royal College of Radiologists

Accelerate diagnoses with direct GP scan requests, improving outcomes for cancer patients. Learn how technology and guidelines optimise efficiency in healthcare.


As of December 2023, GPs in the NHS gained the ability to directly request scans for patients showing ambiguous symptoms, bypassing the need for a specialist hospital referral. This NHS-backed initiative aims to expedite diagnoses, minimise delays and enhance patient outcomes. Following December 2022 guidelines allowing GPs to refer for scans in suspected cancer cases, the directive expands to cover respiratory and heart conditions.

Empowering GPs with timely diagnostics

Traditionally, patients with vague symptoms experienced prolonged waits for tests or consultations with specialists, leading to delays in initiating crucial treatments. The NHSE guidance empowers GPs to exercise their clinical judgment by ordering ultrasounds, brain MRIs and CT scans for symptoms such as coughs, fatigue and dizziness.

Direct referrals enhance cancer care

For patients with cancer, time is of the essence. Quicker diagnoses translate to less invasive treatments, improved recovery and better survival rates. Prior to direct referrals, about one in five cancer cases (67,000) a year were identified after routine testing following referral.

Throughout the programme’s first six months (Dec 2022 – May 2023), GP-referred tests rose by 13%. However, granting GPs direct access raises a critical question: do the potential benefits outweigh the risks?

The NHSE guidance empowers GPs to exercise
their clinical judgment by ordering ultrasounds,
brain MRIs and CT scans for symptoms
such as coughs, fatigue and dizziness.

Optimising scans and minimising risk

Considering GPs’ limited formal radiology training, concerns arise about their ability to select the appropriate scans, potentially leading to costly repeat scans and treatment delays — detrimental to the NHS and patients.

In response, the Royal College of Radiologists developed the iRefer guidelines in 1989, accredited by NICE for over 10 years. This system enables GPs to order the right scan initially, speeding up diagnosis and saving lives, time and resources.

iRefer also provides important radiation dosage details, helping find the right balance between cost and benefit for cancer patients. Excessive radiation, while effective against cancer cells, can also damage healthy cells. iRefer’s ionising radiation dosage information supports these complexities, enhancing patients’ chances of recovery.

Embracing medtech for efficient care

Medtech — a current buzzword — is optimising available technology and helps manage the delays caused by workforce shortfalls. This is why we need to embrace change while mitigating risks. With the right GP support, the healthcare system can operate efficiently, enabling earlier disease detection and saving more lives.

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