Haematuria New Guidelines - FOI Response Register

I am writing to enquire about the actions the NHS Sheltand Health Board has taken to encourage awareness amongst General Practitioners of the National Urology Referral and Management Pathways on Visible and Non-Visible Haematuria that was revised in August 2022.

I represent Fight Bladder Cancer, a charity that supports people affected by bladder cancer, raises awareness of the causes of bladder cancer and its treatments, campaigns for research into this much-ignored cancer, and advocates to improve bladder cancer patient care. In Scotland, nearly 1,700 patients are diagnosed with invasive and non-invasive bladder cancer every year. Unfortunately, over half of bladder cancer patients still present with advanced (and even metastatic) cancer, meaning that not only does the likelihood of cure drop significantly, but the treatment becomes more debilitating. This is reflected in the five-year survival rates for bladder cancer in Scotland being the lowest in Europe.

One of the main areas of concern that Fight Bladder Cancer works to address is the late diagnosis of bladder cancer patients, which often results in poorer patient outcomes and higher mortality rates. Late diagnosis of bladder cancer patients also creates significantly higher costs in ongoing treatment for the NHS.

We recognise the difficulties GPs face when deciding whether to refer patients with possible bladder cancer symptoms for further testing. For example, haematuria is a symptom of bladder cancer, but the chances of it signifying cancer is quite rare, which creates difficulties for GPs deciding when to refer patients, especially in the case of women.

Current national guidelines in the UK complicate this further, as patients with differing ages and sexes are recommended for referral depending on the presentation of different symptoms. This particularly impacts women and people aged under 60. Women of all ages with recurrent UTIs face difficulties in getting referred and diagnosed, and younger patients with persistent blood in their urine and repeated UTIs are often not referred very late or not at all.

1. Given the critical role GPs plays in diagnosing and directing patients into secondary care for timely treatment, we would like to know how your health board is prioritising uptake of these new guidelines and whether there will be any evaluation of how the new guidelines are working in helping GPs identify bladder cancer when presented with patients reporting either gross haematuria or recurrent UTIs. We would welcome the opportunity to discuss this further.

We recommend all our clinicians refer to the Scottish Referral Guidelines for Suspected Cancer (https://www.cancerreferral.scot.nhs.uk/Home) and have no plans for evaluation currently.