This briefing is to inform GP practices of the planned expansion of the Self-Request Chest X-Ray service across Leicester, Leicestershire and Rutland, and to clearly set out the responsibilities of practices and GPs within the pathway.

The service enables eligible symptomatic patients to request a chest X-ray without needing a GP appointment first. The aim is to reduce barriers to investigation, support earlier diagnosis of lung cancer, and improve access for people who may otherwise delay, avoid or struggle to access primary care.

Background

Early diagnosis of lung cancer is critical to improving outcomes. Lung cancer remains one of the leading causes of cancer mortality, and outcomes are strongly linked to stage at diagnosis. Chest X-ray is the first-line imaging test for many people with symptoms that could indicate lung cancer.

The Self-Request Chest X-Ray model was piloted in Coalville with three participating GP practices. The pilot allowed symptomatic patients aged 40 and over to contact the imaging booking team directly and, where eligible, be booked for a chest X-ray without a prior GP consultation.

The pilot demonstrated that the pathway can increase access to chest X-ray for symptomatic patients and can identify clinically significant findings, including lung cancer. The learning from the pilot is now informing expansion across LLR.

Why the service is being expanded

The service is being expanded because it:

• reduces the need for patients to secure a GP appointment before accessing a chest X-ray.
• provides an alternative route for patients who may delay seeking help.
• supports earlier investigation of symptoms that may represent lung cancer.
• complements, rather than replaces, existing GP referral routes.
• may help reduce inequalities in access to diagnostic testing.
• provides a practical and relatively low-cost route to increasing appropriate CXR activity.

Who is eligible to use the service

Patients may be eligible if they:

• are aged 40 or over.
• are registered with a participating LLR GP practice.
• have symptoms that may be consistent with lung cancer as per NG12.
• have had symptoms for more than three weeks.
• have not had recent chest imaging within the exclusion period.

How the pathway works

1. The patient sees service information through local promotion or is signposted by a health, care or community professional.
2. The patient contacts the dedicated booking route.
3. Imaging administration checks the patient against the agreed inclusion and exclusion criteria.
4. If the patient is eligible, imaging administration records the request, including symptoms, duration of symptoms and smoking status, and books the chest X-ray.
5. The CXR is performed and reported in the same way as a GP-referred chest X-ray.
6. The CXR report is returned to the patient’s registered GP practice.
7. Follow-up imaging, such as repeat CXR or urgent CT, may be arranged by imaging in line with agreed pathways where indicated. This will be clearly indicated on the report.
8. The GP practice remains responsible for reviewing the report and acting on the findings and requesting any additional imaging as recommended and not already booked.  

Key message for practices

This is not a separate diagnostic pathway that sits outside primary care. It is an alternative access route into chest X-ray, but the result comes back to the patient’s registered GP practice and must be managed in the same way as other GP-referred imaging results.

GP and practice responsibilities

1. Awareness and signposting

Practices should ensure relevant staff are aware that the service is being expanded and understand which patients may be eligible.

Practice teams may signpost eligible patients to the self-request route where appropriate. The service should be framed as an additional access route for symptomatic patients, not as a replacement for urgent clinical assessment where this is needed.

Practices should refrain from sending text messages to all patients to inform them of the service. Promotion will be via a co-ordinated media campaign. A poster for display in practice waiting rooms is also in development. Further information can be found on the main website: Self-Request Chest X-ray - LLR ICB

2. Clinical judgement remains essential

Patients with concerning, severe or urgent symptoms should still be clinically assessed through usual routes. The self-request CXR pathway should not delay urgent GP review, same-day assessment, USC referral, emergency care or other investigations where clinically indicated.

Practices should continue to use NICE NG12 and local suspected cancer pathways as usual.

3. Practices are not expected to pre-authorise every request

Patients using the self-request route do not require a GP appointment before the chest X-ray is booked, provided they meet the agreed eligibility criteria.

Eligibility checking and booking will be undertaken by the imaging administration team using the agreed protocol.

4. Registered GP as referrer for reporting purposes

For operational purposes, the imaging request is recorded with the patient’s registered GP/practice as the referral source, and the CXR report is returned to the registered GP practice.

Practices should therefore ensure that incoming SRCXR reports are identifiable, reviewed and actioned through their usual test result processes.

5. Responsibility for reviewing results

GP practices are responsible for reviewing CXR reports returned to the practice and ensuring appropriate action is taken.

This includes:

• reviewing normal, abnormal and incidental findings.
• documenting actions taken.
• contacting the patient where required.
• arranging appropriate follow-up, referral or safety netting.
• ensuring results are not left unactioned because the original request was patient-initiated.

6. Abnormal or suspicious findings

Where a CXR is suspicious for cancer, imaging may arrange urgent CT in line with existing agreed processes. However, the GP practice remains responsible for ensuring the report is reviewed and that the patient is appropriately followed up.

This may include:

• confirming that urgent CT has been arranged where indicated.
• making or supporting a suspected cancer referral where required by the local pathway.
• ensuring the patient understands the next step.
• checking that onward referrals or follow-up actions have been completed.
• documenting the plan in the clinical record.

7. Incidental or non-cancer findings

Incidental findings and non-cancer abnormalities should be managed through standard primary care processes unless the report specifies an alternative pathway.

This may include:

• repeat imaging.
• treatment for infection or other respiratory conditions.
• referral to respiratory medicine or another specialty.
• further blood tests or clinical review.
• ongoing monitoring and safety netting.

8. Normal chest X-ray results

A normal CXR is reassuring but does not completely exclude lung cancer or other significant pathology.

Practices should ensure that patients with ongoing, persistent, recurrent or worsening symptoms are reviewed and managed appropriately, even if the CXR is normal.

Safety-netting should include clear advice that patients should re-contact the practice if symptoms persist, worsen or new symptoms develop.

9. Patient communication

Practices should ensure there is a clear process for communicating results to patients.

The local pathway should confirm whether patients are asked to contact the practice for results, whether practices proactively contact patients, or whether a mixed approach is used.

As a minimum, practices should ensure that:

• abnormal results are communicated and actioned promptly.
• patients with significant findings understand the next step.
• normal results are available to patients through agreed practice processes.
• persistent symptoms are safety netted.

10. Coding and record keeping

Practices should record relevant actions in the patient record, including:

• receipt and review of the SRCXR report.
• any patient contacts.
• safety-netting advice given.
• referrals made.
• follow-up imaging requested.
• onward management plan.