Safety netting

The Cancer Task Report and NG12 NICE guidelines 'Suspected cancer: suspected cancer recognition' (2015) both highlight the need for rigorous safety netting when making a suspected cancer referral, requesting direct access diagnostics or to re-appraise the clinical picture in order to reassess a patient’s risk of cancer. 

Historically GPs have implemented verbal and written safety netting methods. There is wide variation in methods of safety netting and practices are asking for practical solutions rather than principles and theory. The advent and drive toward direct access diagnostics within primary care widens the possibility of delays or misses along the suspected cancer pathway as the responsibility shifts towards the referring clinician and practice.

Best practice extends beyond the individual clinician or GP. In-practice safety netting systems should be stringent and sustainable in order to avoid a setup that is solely clinician or individual reliant. Technical advancements in patient health care records have enabled electronic safety-netting methods to minimise stress for patients and GPs and ensure a seamless and safe process whereby practices, involving administrators and clinicians, can proactively track patients who undergo one of the following:

  • Suspected cancer referral
  • Direct access diagnostics to confirm or exclude a cancer
  • Monitoring of patient symptoms where risk needs to be re-evaluated

Electronic safety netting is the method recommended that provides practices with a rigorous, robust, traceable and auditable pro-active approach to tracking patients where needed, for example suspected cancer referrals. It relies on high quality record keeping in the patient healthcare record and the use of functions including alerts, tasks, read or SNOMED codes, electronic referrals, diary entries, follow up codes and text messaging.

Naturally electronic safety netting can be applied beyond the realm of cancer illustrating its transformative scope and potential within primary care. Transforming cancer services team (TCST) recommends the following actions be considered as part of the GP/dental practice suspected cancer safety-netting system, including when a patient is referred for direct access diagnostics:

  1. Offer a timely review and action after investigations have been requested.
  2. Actively monitor symptoms in people at low risk to see if their risk of cancer changes.
  3. Where appropriate reassure people who are concerned that they may have cancer that with their current symptoms their risk of having cancer is low.
  4. Explain to people who are being offered safety netting which symptoms to look out for and when they should return for re-evaluation. It may be appropriate to provide written information.
  5. Ensure that results are reviewed and acted upon promptly and appropriately; the healthcare professional who ordered the investigation taking or explicitly delegating responsibility for this. Be aware of the possibility of false-negative results for chest X-rays (NG12, 2015).
  6. Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action.
  7. The review may be planned within a time frame agreed with the person or be patient-initiated. If new symptoms develop, the person continues to be concerned or their symptoms recur, persist or worsen.
  8. Read code suspected cancer referrals and direct access diagnostics e.g. fast track suspected (breast) cancer referral, referral for ultrasound investigation.
  9. Track patient attendance and outcomes for blood tests/ imaging/ endoscopy/ suspected cancer outpatient appointments using the relevant software, e.g. ICE software, tQuest list management.
  10. Pro-active recall to review patients who do not attend their appointment for diagnostics / suspected cancer/ two-week wait clinic within the time frame agreed.

TCST are developing electronic safety netting guides for EmisWeb, Vision and SystmOne for pan-London primary care professionals.

Queries and support

If you have any suggestions for improvement or queries regarding electronic safety netting please contact Dr Ishani Patel, Clinical Advisor. For general queries please contact Ms. Zara Gross, Project Manager.

Email contact: england.tcstlondon@nhs.net

Useful resources