England's Doctor Advice System Risks Missed Cancer Diagnoses

Advice and guidance services for doctors in England, intended to reduce unnecessary hospital visits and waiting times, are now linked to risks of missed or delayed illness detection. An investigation by the Health Services Safety Investigations Body (HSSIB) found that while these services can improve communication, their poor implementation has contributed to patient harm, including delayed or missed diagnoses, particularly for suspected cancer.

Gaps in system implementation have been identified, with some pathways forcing GPs to use advice services instead of direct referrals, or rejecting referrals despite persistent concerns. The HSSIB has recommended that NHS England and the Department of Health and Social Care rapidly evaluate these services to address resource and capacity issues, training needs, and reporting weaknesses.

NHS England acknowledges the benefits of advice and guidance but states that more work is needed to ensure effectiveness and safety. They are providing clear guidance and tools and have commissioned an evaluation of the service's impact. GP surveys indicate concerns, with a quarter of referrals reportedly sent back as advice and guidance, and significant delays in responses.