New cancer treatment guidelines

Thursday 1st October 2015
Article by Suzanne Trask - A partner and head of the clinical negligence department at Bolt Burdon Kemp
Suzanne Trask - Bolt Burdon Kemp
The National Institute for Health and Care Excellence (NICE) has published updated symptom-based guideline, offering more extensive instruction around how GPs should treat and refer patients who may have cancer.The last guidance was published in 2005 and in recent years it’s been reported that there is a significant variation in the numbers of cancer referrals being made. To address this, the new version lowers the threshold of symptoms for patient referral; it is hoped that this will lead to more patients with concerning symptoms being referred earlier. In turn, more investigations for cancer will be conducted.

This is in the context of an individual GP only seeing a handful of new cancer cases each year. The guidance aims to provide clarity to GPs around when they should set in motion the referral process, potentially leading to an earlier diagnosis.
Cancer symptoms can be very generalised, so can be mistaken for more common conditions. The lower threshold will no doubt lead to more referrals, and will accordingly lead to more false alarms. However, it is hoped that it will catch some cancers earlier to lead to a better outcome for those patients. We will see an increased demand for diagnostic testing, although to make the most of the patient’s earlier referral, the testing will need to be processed more quickly.
The law states that a doctor must act in accordance with a practice accepted by a responsible body of medical opinion at that time. This applies even if the body is a minority one. Guidelines produced by NICE are not legal requirements. However, it is unlikely that a doctor following its guidance would be found negligent. It is, moreover, not absolute; if a GP feels they can identify a good reason to depart from the guidance on a specific occasion, and their approach is also consistent with a responsible body of medical opinion, they are then unlikely to be found to be negligent in an eventual claim.
Where a doctor departs from the guidance with no good reason, for example fails to refer someone appropriately to a specialist, or for tests, it is likely that this would be substandard treatment in the eyes of the law.
In a negligence claim, an independent doctor with a similar level of experience to that doctor providing the treatment (such as a GP) would act as the expert assessing the standard of care that had been provided. An oncology expert would then determine whether the delay has made a difference to the patient’s condition, treatment and outlook. Should the delay have caused a difference, then compensation for both this, and financial losses arising from the delay are likely to be awarded to the patient. GPs will need to follow the new guidance and refer patients earlier and more often. This move towards a lower threshold for referral will change the standard of care that they are required to provide.
This is clearly a very welcome development which should lead to more cancer patients getting the medical attention they need at an earlier time. As the outlook for a cancer patient will often depend on how quickly they are diagnosed and treated, this should in turn improve.