Safety netting

Safety netting in general practice is a way of ensuring that systems are in place to provide safe monitoring and follow-up for patients. Safety netting is an important part of cancer referrals and investigations. It can help to reduce clinical risk, manage diagnostic uncertainty and support timely diagnosis of cancer.

Robust safety netting should reflect three core elements:

1. Patient communication
2. GP actions during consultation
3. Practice processes and systems

Safety netting remains a prioritised activity within the Cancer DES for 2025/26 as part of improving referral practice. Our network of PCN Facilitators can support you to scope and develop safety netting quality improvements.

Safety netting and quality improvement

Primary Care Networks should support practices to review their safety netting processes, as they can play a vital role in:

• Agreeing some standard processes and principles across constituent practices.
• Supporting updates and learning sessions including using safety netting review tools e.g. those developed by Macmillan and Cancer Research UK.
• Encouraging the use of safety netting templates within clinical systems.

Below are some potential practices and workstreams to consider at PCN and practice level:

Patient Communication

• Patients should be given written information regarding urgent suspected cancer referral processes, when to expect to be contacted by secondary care and what to do if they are not contacted. See 👉 urgent suspected cancer referral patient information leaflets.
• Patients are told what symptoms to look out for (red flags), are advised on what to do if symptoms worsen or do not resolve (where appropriate with a time-frame).
• Patients are clearly advised why diagnostic tests and/or repeat tests are important.
• Use appropriate materials if health literacy and/or specific communication needs are identified.

 GP actions – during consultation/following consultation

• Safety netting advice is clearly documented in patients notes, shared with patient and if appropriate carers
• Appropriately code in the patient records that safety netting advice and processes have been put in place. Safety Netting Code: Delivery of safety netting for patients on urgent referral pathway for suspected cancer Practices can search for this by putting in ‘cancer safety netting’ into their (Read) code browser and will find the code 1239431000000107.
• Send appropriate tasks to self and/or colleagues depending on systems in place.
• Use clinical system safety netting templates such as 👉 Ardens fast track safety netting tools

PCN and practice processes and systems

For the PCN Early Cancer Diagnosis DES, primary care network leads, practice managers and system leads should consider a minimal standard including shared systems to ensure:

• Patients referred under urgent suspected cancer referrals are seen by secondary care and if not are contacted by the practice and appropriate actions taken.
• Patients who need a deferred urgent suspected cancer referral are referred at the appropriate time.
• Patients referred for diagnostic radiology to exclude cancer (such as CT for pancreatic cancer or vague symptoms, repeat CXR or US ovaries for a patient with raised CA125) have the investigation in a timely manner and if not are followed up by the practice.
• Referrals and investigations for suspected cancer by locum doctors should have an identified person to follow up on safety netting interventions.
• Cover ill health (both expected and unexpected) in the clinical team (doctors and nurse practitioners) to ensure that patients with suspected cancer are followed up appropriately.
• Use e-safety netting tools (link to e- safety netting section below).
• Practice has a process to hold urgent suspected cancer referrals when the patient is unable to attend i.e. working away or holidays until the patient is able to safely attend.