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GPs use a technique called safety-netting to ensure their patients come back to the surgery for a follow-up appointment. This is very important when patients have symptoms that could lead to an important diagnosis such as cancer. At the moment, GPs use a lot of different ways of safety-netting which are often not organised well. One way to safety-net could be for the GP practice to have a computer system that highlights abnormal test results or that identifies patients who have not attended for their appointments.

Initial objectives

This study is designed to evaluate a safety-netting system that is available in general practices in England, called the E-SN toolkit. The toolkit provides clear ways to track and follow up patients, and we are particularly interested in seeing if it makes a difference to the speed of cancer diagnosis.


We are recruiting 60 general practices who are not currently using the E-SN toolkit, and randomly allocating them into clusters (groups) of 10. Each cluster has the E-SN toolkit turned on at a different time during the 12 months of the study. Once the E-SN toolkit is turned on, the GPs in the practice are able to use it when caring for any patient they think would benefit from it, although we expect that it will be of most use when treating patients with symptoms that might indicate cancer.

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 introduction of the E-SN toolkit makes any difference to the diagnosis of cancer, and in particular to how quickly patients are diagnosed. We will only extract records from patients who are over 18, and who have not opted out of the research.

Our main (primary) outcome is the “primary care interval”. This is the number days between the 1st recorded symptoms of cancer (within the year prior to diagnosis) and referral to secondary (usually hospital) care. 

We are also carrying out interviews with GPs and practice staff to understand how the E-SN toolkit works in practice, and how it could be improved.  Since some practices will have been using the E-SN toolkit during COVID-19, we are also asking about how this has affected their safety netting processes.

Find out about our extension project here