Exploring GP Access to Brain Scans

Today, we’ve launched a new report for England, Exploring GP Access to Brain Scans, that shows GPs based in England need much better and consistent access to diagnostic scans if we’re to see improvements to brain tumour diagnosis times.

We know from our previous research that getting a brain tumour diagnosis can be particularly tricky. People affected by brain tumours have told us time and time again just how difficult this can be – from needing to see a GP multiple times, to not feeling believed or heard by healthcare professionals.

Why have we written this report?

One of the ways that diagnosis can be sped up for the brain tumour community is allowing GPs to directly order a diagnostic scan, such as a brain MRI or CT, instead of the GP having to refer onto a hospital department. Referrals often mean that somebody with a suspected brain tumour needs to wait for their appointment with the team at the hospital and then wait for another appointment for a scan.

Eighteen months after the guidance had been published, we wanted to delve a little deeper to see how it’s being used by GPs and if it’s helping our community. The results, however, were a little disappointing.

To carry out our research, we interviewed 15 different healthcare professionals across England, held a focus group and also worked with InHouse Research on a survey of 100 GPs.

GPs don’t know about the guidance

The first major barrier to GPs using the guidance was that knowledge of it was patchy. Several of the GPs we interviewed didn’t know there was new guidance that could allow them to send people with symptoms suspicious of a brain tumour directly for a scan. This was backed up by the survey we carried out which found that a third of the respondents (33%) answered that they “did not know that NHS England published guidance stating that you can directly request for MRI brain imaging if a patient presents with symptoms suspicious of a brain tumour”.

Part of the difficulties with GPs finding out about the guidance was that they get multiple guidance updates daily, so knowing which ones to keep track of is incredibly difficult. There doesn’t seem to be a consistent system that means GPs are updated or told about what’s important. It seems to rely on individual GPs spotting something, thinking it may be of interest and sharing with their colleagues.

Because we get so much stuff all the time…it just takes a member of our team to have spotted it in the stuff that we all get bombarded with every day to notice it and share it.

Anonymous GP

The Department of Health and Social Care must work across England to ensure the guidance is disseminated and implemented consistently. This will make it easier for GPs to know that they’re able to directly send patients who may have a brain tumour for a diagnostic scan that could make all the difference.

GPs have variable access to brain scans in their areas

Another major barrier highlighted in our report is that, even if GPs did know they can send a person directly for a brain MRI or CT scan, in some areas they aren’t able to because it isn’t a locally commissioned service. This means that the local health system has decided not to make a particular service available for GPs.

We don’t have the facility to order MRI scans as GPs, except for knee and back…it’s just not a commissioned service. It’s not being offered to us.

Anonymous GP

In some areas, there potentially was the service to order a brain MRI or CT scan but GPs just didn’t know who provided that service – for example, if it’s the local hospital, a private provider or another service – or how they would order it. Our survey results told a similar story with one in five GP respondents (19%) stated that they didn’t know “who provides the scan”.

Even if the guidance had been disseminated well amongst GPs, if GPs then don’t know how to order the scans or, worse, they aren’t able to order them in their area then people with a suspected brain tumour are still going to experience delays in getting their diagnosis.

Brain MRIs and/or CT scans must be commissioned in every area across England to ensure every GP is able to order them for patients. It must also be made very clear to GPs who provides the scans and how they can order them.

What can be done?

Because of the difficult nature of diagnosing brain tumours, we want more than just guidance for GPs. Our report shows that what’s clearly needed is a full and comprehensive pathway that makes sure GPs know how and who to send for a scan, and when.

Even when available, GPs are hesitant to use the guidance for people with suspected brain tumours because they aren’t sure what happens after the scan results come back. If a scan comes back from radiology and says there is a concerning result that could be a brain tumour, there isn’t currently a clear route for GPs to know what to do next or where to send that patient on to.

One GP we interviewed said exactly this and emphasised that there’s a need to have “pathways for what you do about abnormal findings – do they go back to the GP do they go onto an MDT (multi-disciplinary team), etc”. Our survey results echo this with a third (34%) of responding GPs, who had experience using the guidance, answering that they weren’t told what to do next.

We spoke to one group in the West Midlands who’d set up a full pathway for people with symptoms that are suspicious of a brain tumour which was working very well. This included guidance around exactly who should be scanned for a potential brain tumour, including a full symptom list, exactly who shouldn’t be scanned, including an alternative route for those patients, and then exactly what should happen in each scenario when the results came back.

Thoughts of the Royal College of GPs

Following the publication of our report and its findings, Professor Kamila Hawthorne, Chair of the Royal College of GPs (RCGP), said: “We know just how difficult and distressing it can be for patients who are concerned about neurological symptoms. As such, being able to quickly and directly refer patients for appropriate testing can ensure they get peace of mind, or timely treatment if required.  

“It is concerning to hear that the ability for GPs to do this, and understanding of the appropriate pathways for referral, are not as widely known amongst GPs as we would like, so we would certainly support efforts to raise awareness across the profession. It’s also vital that pathways for referral and associated guidance are as simple and streamlined as possible, so that they don’t become a barrier to referrals and patients accessing potentially life-saving tests. But we also know that insufficient numbers of MRI scanners are driving limitations in diagnosis and causing delays for hospitals.  

“We also support the recommendation in The Brain Tumour Charity’s report calling for the GP workforce to be significantly increased, to allow us to deliver the best possible care for our patients. Primary care is badly overstretched and understaffed, the forthcoming new 10-year Health Plan must be used as an opportunity to allocate a much greater portion of the NHS budget to primary care so we can provide the care and services that our patients need and deserve.” 

We thank the RCGP for their response and support and look forward to continuing to work with them going forwards.

Brain tumours need a clear diagnostic pathway

We know the traditional cancer diagnostic pathways aren’t working for brain tumours, partly because brain tumours are more difficult to diagnose than other cancers. To recognise this and ensure brain tumours aren’t being left behind, the Department of Health and Social Care must create a full and comprehensive pathway for suspected brain tumours.

Diagnosis is difficult for the brain tumour community, and we keep being left behind by subsequent pathways and guidance that doesn’t work for us. This is exactly why we continue to call on the government to develop a National Brain Tumour Strategy. An important part of the diagnosis pillar must be around creating a specific pathway for people with symptoms that are suspicious of brain tumours.