Safety netting during Covid-19: why bother?
Many GPs worry about missing a cancer diagnosis especially when patients present with non-specific or vague symptoms e.g. fatigue, weight loss or abdominal pain.
Yet according to the last National Cancer Diagnosis Audit findings, only 44% of cancers diagnosed in 2014 had any safety netting recorded, representing an opportunity to improve the quality of our care for patients.
During Covid-19, the challenge has increased. We have witnessed a significant drop in 2ww referrals, with referral rates still far below average.
There are several reasons for this: patients not contacting GPs in the first place, patients not wanting to be referred onwards for fear of catching the virus, or secondary care services including (community) diagnostics not being available. We also know that secondary care is carrying out risk assessment for patients which means responsibility of the patient and safety-netting is ever more important to be clarified and managed
Cancer Research UK (CRUK) has estimated that this dramatic reduction in referrals will miss over 2,300 new and as yet undiagnosed cancers per week in England alone. Consequently, delays to diagnosis and treatment make early diagnosis and survival ambitions more challenging.
Using a consistent and robust practice-wide system of safety netting represent opportunities for earlier diagnosis and will help minimise this issue and will benefit patients with possible signs and symptoms of cancer now during Covid, but also during the recovery phase and beyond.
What is safety netting?
Dr Pawan Randev, a Cancer Research UK GP in Leicestershire, continues to promote safety netting as an important process to help manage diagnostic uncertainty and support the timelier diagnosis of cancer. He says: “This is especially important during the Covid-19 pandemic. However, most practices aren’t consistently safety netting, even though they think they are. Often there are varying processes used by clinicians too.”
Free resources to help you
Most recently CRUK has published recommendations for safety netting during the Covid-19 pandemic .
However, there are many other resources available on the Cancer Research UK safety netting hub including:
- self-assessment checklist and workbook
- infographics showing safety netting processes and flowchart
- best practice suggestions
- signposting to clinical system ‘how to’ guides for SystmOne and EMIS web
Recommended action for GP practices and for PCNs
Dr Pawan Randev suggests:
- Download the Covid special Cancer Insight on Safety Netting and share with your primary care colleagues
- Enquire about free tailored support for your practice or PCN from your local CRUK Facilitator. Facilitators can:
- Provide free workshop for your practice or PCNs and tailored assistance in safety netting involving PCN clinical and administrative teams
- Use the workbook and self-assessment checklist on the CRUK Safety Netting hub. Facilitate discussion at practice or PCN level between your practices about the current safety netting processes being used. Agree what best practice looks like and how you will collectively implement a consistent approach, including using Snomed codes when available later in 2020 (as part of the PCN specification on the early diagnosis of cancer)
- Tell other primary care colleagues about the importance of safety netting, especially during Covid-19 e.g. set up a discussion on your WhatsApp group.
Find out how your clinical system can support safety netting becoming embedded in your practice
Any practices using SystmOne should take a look at this short video which demonstrates how to incorporate safety netting into their GP clinical system. GPs may find it useful when considering safety netting patients referred on a 2ww referral. This video covers just one aspect of the safety netting management strategy for patients, tests and referrals used in the context of diagnostic uncertainty in healthcare. It aims to ensure patients are monitored until signs and symptoms are explained or resolved
Practices using EMIS Web can also electronically safety netting. EMIS Web uses template/forms to schedule diary reminders in the clinical system and reminds/alerts practice staff to follow up at a later date. To support GP practices implement the toolkit, there is a video guide, a user guide and an admin user guide.