Yeovil hospital pilots scheme to speed up and remove barriers to breast cancer diagnosis

Women with worrying lumps are set to be referred directly to a breast diagnostic clinic through the NHS App, the Health and Social Care Secretary has announced.

This will lead to faster diagnosis for cancer patients and free up more GP appointments, according to Wes Streeting.

From November the local pilot will see the online version of the NHS non-emergency 111 service - available on the NHS app - refer women in Somerset who need diagnostic testing.

Data-based pilot

The trial began with Yeovil Hospital, Somerset NHS Foundation Trust, which had analysed the data to find the “vast majority” of women approaching their GP with a breast-related problem were referred in.

On the back of this, a small number of Yeovil GP practices were referring women into the breast unit (BU) via an agreed proforma completed by practice admin staff (with training). In parallel 111 was reporting about 11 patients from the BU catchment per month contacting them with breast concerns – which they were signposting to their GPs.

The lead breast surgeon clinical lead spearheaded the innovation of 111 using a similar proforma to the GP practice to refer women directly to the BU.

Yeovil is so far the only hospital undergoing the trial, and only in reference to the referral. Once in the breast unit, from whichever route, women undergo triple assessment as per national guidance which includes clinical assessment, mammography request as appropriate by a clinician, any further imaging and discharge or follow up as clinically required.

'Removing barriers to diagnosis'

Sue Johnson, professional officer for clinical imaging, said: “We support removing barriers to diagnosis, one of which can be getting a GP appointment. Direct to test makes a lot of sense but there is a need to ensure that the service can respond appropriately, has staff with the right skills to see patients and plan their diagnostic pathway as well as meeting the regulatory requirements for referral for ionising radiation and ensuring that someone acts on the results of any tests.

“Radiographers (and specialist breast cancer nurses) hold many skills to support direct access clinics, but it would be a new service entry pathway, and it isn't clear whether the number of people would increase if you open up access or whether the same number would come sooner.”

Direct access for breast cancer would also be more complex than for a long-standing cough, for example, where the test of choice is a chest X-Ray and onward referral for a CT scan. For breast lumps, there are more options for initial and onward diagnosis.

“As an organisation, we are supportive of the initiative, but we do have concerns about the potential increase in numbers, as well as ensuring that women receive the right support from initial contact to getting their results,” Ms. Johnson added.

Understanding impact on services

The scheme will help to free up appointments that could not have been referred directly in this way, according to the Department for Health and Social Care.

Health and social care secretary Wes Streeting said: “The other frustration I hear from staff and patients alike are the pointless appointments you’re forced to hold and patients are forced to attend. You didn’t go through 5 years of medical school plus 5 years of training to tick boxes.

“So where there are appointments that can be cut out, with patients seen by specialists faster and GPs’ time freed up to do what only GPs can do, we will act.”

However, a spokesperson for the SoR has warned that organisations will need to understand the impact on services before committing to this particular approach.

(Image: CT scanning team at Yeovil hospital, via Somerset NHS Foundation Trust)