More cancer diagnostic tests could be carried out within primary care networks (PCNs) rather than in hospital settings to better protect patients from Covid-19, NHS England has suggested.
NHS England published guidance today (19 January) – aimed at both primary and secondary care – setting out a number of recommendations on managing cancer diagnoses safely during the Covid-19 pandemic.
To protect patients from Covid-19, NHS England said it is important to reduce the number of suspected cancer patients attending hospital settings, and that this could be achieved by providing more initial diagnostic tests, including X-rays and ultrasounds, within primary care.
‘Increasing the capacity of primary care networks to perform initial diagnostic tests such as X-ray and ultrasound could reduce the need for secondary care attendances,’ the guidance said.
This opportunity should be considered in local Covid-19 response plans, it added, including any plans for mobile diagnostic capacity.
The document said: ‘Clinical triage is essential to streamlining the referral process and to ensure patients receive the right tests at the right time. Where available and clinically appropriate, high sensitivity tests should be available by direct GP access pre-referral (e.g. ultrasound for suspected gynaecological cancers or sarcoma, CT or MRI for brain tumours).’
In August, an Institute for Public Policy Research (IPPR) report similarly recommended moving cancer diagnosis and treatment services away from hospitals to ‘Covid-safe’ locations wherever possible to help restore NHS performance.
Adapting current pathways
NHS England said it has received ‘many enquiries’ from providers about how to manage cancer diagnoses safely alongside the Covid pandemic, following its direction to fully restore cancer services on 31 July 2020.
The guidance reiterated that national and local messages should reassure patients about the importance of coming forward for care.
Where patients decline a diagnostic appointment due to Covid fears, they should be offered a teleconsultation to discuss the importance of testing, and what they should do if their symptoms persist or progress, it added.
NHS England said: ‘Local providers should balance the clinical risk of cancer and need for rapid diagnosis with patients’ clinical risk of Covid-19, especially for patients in the shielding group.
‘Cancer investigations for those in the shielding group should take place in Covid-19-secure sites [where] capacity should be prioritised based on clinical need and patient vulnerability.’
The guidance document also said that urgent diagnostic pathways have been impacted by the pandemic – as a result of infection control measures, social distancing, and Covid testing requirements – meaning fewer patients may be seen at any one time.
It added that there is anecdotal evidence of people finding it difficult to arrange travel to healthcare facilities or access support networks during the pandemic, and that these challenges should be considered when coordinating patient care.