Scottish Referral Guidelines for Suspected Cancer
Questions about the tools?
Contact us if you have questions about the tools
The Scottish National Cancer Diagnosis Audit (NCDA) report highlights that the most common route of referral for patients was ‘urgent with a suspicion of cancer’ (42.9%) and 19.2% of patients were referred as an emergency.”[1] Here you can find out more about the Scottish Referral Guidelines and tools available to support primary care in the recognition and referral of suspected cancer.
The Scottish Referral Guidelines for Suspected Cancer (SRG) are recommendations to support GPs and the wider primary care team to manage patients who present with possible symptoms of cancer and facilitate appropriate referral to secondary care. Recommendations are arranged by cancer site, covering well known ‘red flags’ as well as vague, or non-specific symptoms.
The Scottish Referral Guidelines for Suspected Cancer (SRG) were updated in January 2019 and principle updates included [2]
• Recognising the importance of the wider primary care team
• Prompts for patient-centred, informed decision making during a consultation, e.g. what are the benefits/risks/side effects/alternative options?
• Safety netting to help appropriately manage patients
The update focuses on eight cancer pathways:
Lung |
Breast |
Lower GI |
Upper GI |
Brain |
Bladder |
Head and Neck |
Children and Young People |
NHS Scotland have produced a summary of key changes that have been made to the SRG guidelines
The Scottish Government have produced a number of resources (link is external)to help local teams understand and evaluate the impacts and costs of implementing the guidance
Pathways and availability of tests can vary locally so it’s also important to be aware of your specific Health Board guidance. If you’re unsure what’s available to you, contact your Local Medical Council or GP representative.
Click below for a helpful summary of the key actions you can take in managing people who present with non-specific signs or symptoms of cancer.
GP perspective
Dr Anant Sachdev, Cancer Research UK GP highlights in this video, the importance of routinely using suspected cancer referral guidelines despite current complexities around the management of cancer referrals.
Dr Richard Roope, Cancer Research UK Primary Care Advisor highlights in this video, key considerations when managing people who present with non-specific symptoms.
Translating cancer guidelines into practice can be challenging, especially when people present with non-specific symptoms. If this happens, as well as using the Scottish Referral Guidelines, there are some key actions you can take.
Considerations for managing patients with non-specific symptoms
Use primary care investigations where available at point of care, to triage and manage the appropriate routes to send people. Chest X-rays, CT scans and blood tests are usually easily accessible and can help speed up cancer diagnosis.
|
|
Don’t be reassured by negative test results. Chest X-Rays, PSA and CA125 blood tests have false negative rates of 15-25%. | |
Implement robust and consistent safety netting to help manage diagnostic uncertainty. Safety netting is vital for all patients, whether they’re being referred for tests, or specialist advice or not and recorded on the clinical system. | |
Ensure you safety net patients who are not referred for suspected cancer until the symptoms are explained, resolved or the patient is referred. Patients should be given information about any tests they need to have, the next steps and follow up whether they are referred or not. | |
Use tools to make following the guidelines easier (see below) and be aware of local guidance. | |
Use Early Cancer Diagnosis Centre (ECDCs) if available, which provide alternative routes for patients when GPs are unsure which site-specific route would be appropriate. | |
Remember to act on clinical suspicion if you still have concerns. |
Patient case study: test your Scottish Referral Guidelines (SRG) knowledge
Tony is 72 years old and presents to his GP with new appetite loss. He has diabetes and arthritis in his hands, which often makes it difficult for him to sleep and eat. Tony is a non-smoker and has had no exposure to asbestos.
The GP enquires if there are any additional symptoms, to understand if the appetite loss is related to Tony’s difficulty sleeping or not.
- If unexplained or persistent (more than 3 weeks) appetite loss, chest pain, change in cough or new cough, shortness of breath or weight loss is present then SRG recommends offering an urgent chest X-ray
The appetite loss is not persistent and there are no additional symptoms. The GP decides to request several blood tests for additional reassurance that nothing serious is going on.
Which blood tests would you order?
- Several tests could be done at this stage given the non-specificity of Tony’s presentation, but the GP includes: FBC, haematinics, U&E, LFT, TFT, HBA1C, bone profile & ESR
The GP asks Tony to book another appointment in five day’s time, when his blood test results are due back. The blood tests show iron deficiency anaemia, but everything else is normal.
What would you do next?
- Ask Tony to return for another anaemia blood test in a week’s time?
- Refer on to an urgent suspected colorectal cancer pathway?
- Complete a Faecal Immunochemical Test (FIT) and wait for the result to determine whether to make a colorectal urgent referral?
Having discussed the options with Tony, the GP refers him to the urgent referral pathway for suspected colorectal cancer without doing a FIT*, as this is the SRG recommendation for people over 60 with iron-deficiency-anaemia.
Use tools to make following the guidelines easier. Find your preferred tool.
The Scottish Primary Care Cancer Group have produced a quick visualisation tool and app.
A desktop Quick Guide has been developed by the Scottish Primary Care Cancer Group which has been used as the basis for an App for use on mobile devices.
1. Public Health Scotland (2021). National Cancer Diagnosis Audit: Summary Information from an audit of patients diagnosed between 1 October 2018 and 30 September 2019. [Accessed August 2021]
2. NHS Scotland. Scottish Referral Guidelines for Suspected Cancer: cancerreferral.scot.nhs.uk
Last reviewed
GP Insight guide to managing patients with non-specific signs of cancer