Case study: how can effective safety netting support timelier diagnosis across the pathway?

Last reviewed: 10 July 2025

The case study below demonstrates how implementing effective safety netting, including the use of e-safety netting tools, at key touchpoints in the primary care pathway can support timelier cancer diagnosis. It also shows how a patient could be at risk of a protracted time to diagnosis in the absence of these actions.

This case study can be used to support GP and practice training around safety netting. It’s been developed with Dr Sarah Taylor, Cancer Research UK GP and Greater Manchester Cancer Alliance Associate Medical Director for Early Diagnosis and Primary Care. Investigations and referrals noted in the case study are in line with the cancer referral guidelines in all UK nations

John is 62 and a non-smoker.

John’s initial presentation: experiencing persistent fatigue and work-related stress. No other symptoms reported at this time. He has a history of asthma.
GP’s initial impression: likely stress-related fatigue, which does not meet criteria for investigation at this time.
John’s subsequent presentation: ongoing fatigue, and a new cough persisting for more than 3 weeks.
GP’s impression: national cancer referral guidelines
NICE. Suspected cancer: recognition and referral NICE guideline NG12. Accessed July 2025.
NHS Scotland Scottish referral guidelines for suspected cancer. Accessed July 2025.
Northern Ireland Cancer Network (NICaN) referral guidance for suspected cancer. Accessed July 2025.
recommend John warrants a chest x-ray.

This is a caption table example
Opportunity	With effective safety netting	Without effective safety netting
Patient education and communication	On initial presentation to the GP, John is given clear guidance that if the fatigue continues, or if he notices any other concerning symptoms, to return to the GP within a set timeframe (3 weeks) John is provided with written reference of the safety netting advice.	On initial presentation to the GP, John is reassured the fatigue is likely stress-related advised to ‘wait and see’. There is no advice provided on when to re-present, and in what circumstances. No supporting information is reviewed or offered. John assumes the fatigue is normal.
Documentation and use of e-safety netting tools	The agreed action is documented on the system by the GP The practice uses an e-safety netting tool to check whether John makes a follow-up appointment.	No record of the GP’s advice is made on the system and no tools are used to track whether John makes a follow-up appointment.
Outcome	John returns to his GP practice 3 weeks later, with worsening fatigue, and has since developed unexplained shortness of breath. The GP refers John for an urgent direct access chest x-ray (CXR). This comes back negative after 2 weeks.	John returns to his GP practice 3 months later, with worsening fatigue, and has since developed unexplained shortness of breath. The GP refers John for an urgent direct access CXR. This comes back negative after 2 weeks.

This is a caption table example
Opportunity	With effective safety netting	Without effective safety netting
Patient education and communication	John is given a clear explanation of the results of the CXR, and the limitations of the test. He’s told that although his test is reassuring, it doesn’t completely rule out cancer, especially if his symptoms continue or worsen. He’s advised to return if his symptoms persist beyond a further 3 weeks, or he develops any new or worsening symptoms. John and the GP agree to book a follow-up appointment in 3 weeks.	John is reassured that the CXR is negative and that his ongoing symptoms may be related to an exacerbation of his asthma. There’s no explanation of the limitations of CXR and no advice provided on when to re-present, and in what circumstances.
Documentation and use of e-safety netting tools	The agreed action is documented via a template and coded in the system. The practice admin team are alerted to send John a text to remind him of his follow-up appointment.	Safety netting is not documented or coded in the system. John doesn't receive a reminder of his follow up appointment.
Outcome	John attends his follow up 3 weeks later, with worsening symptoms and a new cough. As the GP is still concerned, they decide to refer John for an urgent suspected cancer (USC) referral.	John attends the GP 2 months later with worsening symptoms and a new cough. As the GP is now concerned, they decide to refer John for an urgent suspected cancer referral.

This is a caption table example
Opportunity	With effective safety netting	Without effective safety netting
Patient education and communication	John clearly understands the GP’s concerns and why they’ve completed the USC referral (the GP explained that it is unlikely he has cancer, but important to rule out). John receives a clear run-through of what to expect – that he should receive the appointment within 2 weeks, and to contact the practice if not. He is asked if he understands, given the opportunity to ask questions and provided with a leaflet explaining his urgent suspected cancer referral. John is also given clear instructions with timeframes on what to do if his symptoms worsen/if new symptoms develop.	John is told he is being sent to a lung specialist but without any clear explanation, he’s told it’s just “routine”. John is unaware of the urgency or reason for the referral, and delays attending the appointment as he doesn’t want to take the time off work.
Documentation and use of e-safety netting tools	The referral is coded appropriately and tracked using an e-safety netting tool.	The referral is not coded appropriately, so the practice is unable to track whether there are any delays in John’s referral or appointment.
Outcome	John is seen within 2 weeks and is diagnosed with lung cancer.	John’s appointment is delayed by 4 weeks but he is eventually investigated and diagnosed with lung cancer.

With effective safety netting

John’s journey from initial presentation to diagnosis was around 10 weeks, which could potentially lead to John being diagnosed at an earlier stage with more treatment options available.

Without effective safety netting

John’s journey from initial presentation to diagnosis was around 30 weeks, which could potentially lead to John being diagnosed at a later stage and experiencing worse outcomes.