NICE says GPs need direct access to CT scans

Experts from NICE have advised that GPs should be able to access CT scans directly so that can investigate whether there is a sinister underlying cause of patients’ headaches, such as a brain tumour.

Dr David Kernick, a GP, and Stuart Williams, consultant radiologist, both NICE Fellows, say that the move would dramatically cut the number of secondary care referrals, and thus cost. Headache is the most common reason for neurological referral to secondary care – even though serious causes are rare – and studies have shown an 86% reduction in referrals when GPs had direct access to CT scans, they point out.

They add that patients referred to secondary care tend to consult more frequently, and to be more stressed and anxious, than those being investigated by a GP surgery.

They recommend that CT should be used in preference to MRI, because MRI has about double the number of false-positives, as well as being more expensive and less readily available.

Dr Kernick said: “Around 30% of neurology referrals are for headache and many of these are inappropriate for this setting. The available evidence suggests that GPs can utilise brain imaging appropriately and reduce secondary care costs.”

He and Mr Williams conclude that “the existing evidence suggests that GPs can refer for investigation appropriately and can reduce secondary care referrals.

“We suggest that GPs have direct access to CT unless headache patients present with associated neurological signs when urgent neurological referral is indicated.”