A survey of GPs in England found that a third of respondents did not know NHS guidance meant they could directly request scans for patients with possible brain tumour symptoms.
The survey, carried out by The Brain Tumour Charity, involved 90 GPs across a representative range of locations in England as well as 10 in Scotland.
Of those who responded in England, one in three (33%) didn’t know the guidance existed and, of those who did know, a third felt they weren’t given clear instructions on what to do next. Nearly one in five (19%) did not know who provided MRI or CT scans in their area. The Charity is publishing a separate report for Scotland.
The findings are part of a newly published report highlighting barriers to the implementation of NHS guidance which expanded direct access to diagnostic scans for GPs in England where patients did not meet the urgent scan threshold for cancer.
The guidance was first updated in September 2023 and a year on, NHS England’s Diagnostic Imaging Dataset (i) showed that while the number of brain scans requested by GPs through direct access had increased, the proportion remained static. Just under 14% of all brain MRI scans come through the GP pathway, indicating slow adoption of the guidance. The data also shows 20 scan providers had not received any direct referrals from GPs.
Alongside its survey, The Brain Tumour Charity held in-depth interviews with 15 different healthcare professionals across the country to understand how the NHS England guidance had been disseminated.
The themes that emerged from those interviews were discussed at a virtual focus group with GPs in October 2024. In those discussions, GPs said there was a lack of clarity around referral pathways with some going “back-and-forth” between private providers and NHS hospitals to secure an appointment for a patient, leading to delays in diagnosis.
North London GP, Dr Emily Witt, said:
I had a patient last year who had a headache and when I saw him, I thought there’s something just not quite right. There was actually nothing specific, but something really didn’t feel right…
“I ordered an urgent MRI through a private provider, which is the only way we can order MRIs. They said we don’t accept urgent referrals. So, I then sent an urgent MRI referral to the local hospital, and they said we don’t do brain MRIs for GPs. The patient didn’t fulfil the two-week criteria. So, I then had to send it back to the private provider and luckily, just because of them not having a very long waiting list, they did it within two weeks and he had a big tumour.”
Others said they felt overwhelmed by the volume of NHS guidance updates, or that they had to seek out critical information, rather than receive through a structured, accessible process.
There was also the perception that radiology departments were ‘swamped’, and so GPs should think twice before referring. But a group in the West Midlands has worked with local GPs to set up a specific brain tumour diagnostic pathway which hasn’t found this to be the case.
The report ‘Exploring GP Access to Imaging’ acknowledges that GPs and radiology teams are under huge strain because of capacity issues but concludes: “You can provide GPs with the ability to directly order scans without radiology becoming overwhelmed. This can be achieved through well thought out, locally minded and comprehensive pathways that include exactly who to scan and who not to scan, what happens when a finding isn’t clear and what the onward referral pathway is.”
It builds on recommendations made in ‘Brain Tumours: Fighting for a Faster Diagnosis’ which called for urgent improvements in the early detection and diagnosis of brain tumours, and better support for GPs to access scans directly. Since then, the charity has launched a campaign for a National Brain Tumour Strategy to be implemented across all four nations.
Cameron Miller, Director of External Affairs and Strategy at The Brain Tumour Charity, said faster, better diagnosis needed to form part of a UK-wide National Brain Tumour Strategy, adding:
“Direct access to scans for GPs must be central to any efforts aimed at speeding up brain tumour diagnosis.
“It’s a vital step in ensuring anyone affected by a brain tumour diagnosis has timely access to the best possible treatment options, time to process what they’re going through and the chance to have a better quality of life.”
The Grace Kelly Childhood Cancer Trust supported this work and its Chief Executive, Dr Jen Kelly, said:
“It has been a pleasure to work with The Brain Tumour Charity on this important project.
“Sadly, delays in diagnosis continue to occur in a number of cases, so collaborations such as this are crucial in helping to improve outcomes through shared expertise and coordinated efforts. Through our established connections with primary care and our experience in developing educational resources for GPs on childhood cancers, we have been able to offer input that complements the work of The Brain Tumour Charity.”
