Evaluation of an e-safety netting cancer template in primary care (CASNET2): a pragmatic stepped-wedge Randomised Controlled Study (RCT)


Background and Rationale

GPs use a technique called safety-netting to ensure their patients come back to the surgery if they need to, particularly when they have symptoms that could lead to a diagnosis such as cancer. This technique is regarded as “best practice” yet in the NHS, fail-safes do not currently exist to ensure that tests and referrals are followed-up, and that recurrent consultations are highlighted in patients with unexplained symptoms that could indicate a cancer diagnosis. Patients can be unaware of their responsibility to follow up investigations and referrals. University College London Hospitals (UCLH) Cancer Collaborative and the Transforming Cancer Services Team for London (LC-TCST) have now developed an electronic safety-netting toolkit: the E-SN toolkit, through consultation with GPs across London, which can be integrated into the electronic health records (EHR) system EMIS.

The objective of this study is to assess the E-SN toolkit in UK primary care to identify whether it helps GPs to follow up test results, highlights if patients do not make follow-up appointments and improves outcomes for patients with symptoms that could be indicative of cancer. This will enable us to compare the diagnostic and consultation outcomes and measure the variation in the use of the E-SN toolkit between GP practices, and describe the clinical situations for which the E-SN toolkit is used by GPs.

What is the design of the study?

In collaboration with Professor Bankhead and Dr Nicholson at the Nuffield Department of Primary Care Health Sciences, University of Oxford, we will conduct a randomised trial to test the activation of the E-SN toolkit integrated into the practice’s EMIS electronic health record system. We will ask 60 GP practices who are members of the RCGP Research and Surveillance Centre (RSC) to take part in the trial where they will be randomised into one of 6 clusters. Practices will receive training in use of the toolkit, prior to activation. Once training is complete the GPs in the practices will be able to use the toolkit when treating any patient, although we expect that it will be most useful when treating patients with symptoms that might indicate cancer.

Although there will be no requirement for GPs to use the E-SN toolkit, we hope that they will choose to do so.  Patients are unlikely to observe any change in their consultation as use of the toolkit will only add a very short time to the recording of their consultation. We will collect data from the electronic patient record system from the 12 months of the study and the 24 months before the start of the study to understand whether the tool makes any difference to the diagnosis of cancer.  We will only extract records from patients who are over 18, and who have not opted out of record sharing.

This Study was completed on 31 October 2021. 

Thank you to all practices that took part.