Safety netting and clinical coding
Cancer electronic safety netting toolkit for GPs
We have created an electronic safety netting (E-SN) toolkit for cancer that can be used by GPs faced with various cancer-related clinical situations. The toolkit gives GP practices a template/form that schedules diary reminders in their system and reminds and alerts practice staff to follow up later.
EMIS Web made our solution nationally available on their system from mid-2018, so all GP practices using EMIS Web are able to access the toolkit for free.
Toolkit development
The toolkit concept was conceived in collaboration with the former Transforming Cancer Services Team for London and throughout it has had Macmillan’s support and advocacy to enable the strategic direction. The toolkit has undergone a feasibility trial and several improvement cycles conducted by the North Central London Cancer Alliance to reach its final comprehensive version.
There is a full report on the development and implementation of the Electronic Safety Netting toolkit. A summary report is also available.
The E-SN toolkit features in the NHS England Cancer Digital Playbook, accessible via NHS Futures, which highlights digital tools that can be used to support the delivery of patient pathways.
Our E-SN toolkit enabled us to collaborate with academic colleagues from Oxford University and wider, to win an Early Detection and Diagnosis grant from Cancer Research UK to explore the impact of implementing this E-SN toolkit in GP practices. You can read the protocol for this paper in the British Medical Journal.
Early findings from this trial have also been published on the Oxford University website.
Casnet2: Evaluation of electronic safety netting for suspected cancer
“We also compared people diagnosed with cancer after the safety-netting tool was used as part of their care to people who were diagnosed before the tool was turned on. We found that in patients who had the tool used as part of their care, the time to referral was an average of 53 days shorter and the time to diagnosis was an average of 32 days shorter.”
Implementing the EMIS Web E-SN toolkit in practice
To support GP practices in implementing the toolkit we have produced a video user guide.
The other resources which help practices implement this tool are:
Since 2018 the toolkit has had several updates so some of the screenshots may not reflect the current toolkit form. However, the over overarching steps in the guides remain unchanged and are relevant so can be used to support implementation.
We have produced an updated train-the-trainers guide to support deployment of the E-SN toolkit. This presentation contains screenshots of the toolkit from 2025.
Monitoring and evaluation
This document sets out how you can measure the use and activity of the E-SN template in your practice.
Since our initial work there has been a surge of new E-SN tools. We have worked with academic colleagues to develop a systematic way to appraise such tools. Our paper on this evaluation is in JMIR Medical Informatics.
Case studies of E-SN operational models
The toolkit is being used across the country in practices with EMIS Web. As the innovator organisation, it has been revealing and rewarding to learn how different primary care organisations across different boroughs have implemented and adopted the toolkit to fit their needs. This document presents a selection of case studies across London to showcase how E-SN can be applied and sustained in a variety of ways across different scales of primary care.
Good quality coding
Central to effective safety netting is good coding of information. We have created an e-learning module with Macmillan Cancer Support – Coding and safety netting in the context of cancer – which is available in their Learning Hub. Access is free but users must register to use.
The course is suitable for GPs, GP trainees and other primary care clinical staff.
The aims of the course are:
- To be aware of the clinical and non-clinical implications of coding
- To raise awareness of the benefits of coding and safety netting in improving clinical care, diagnosis and community management of individuals with cancer and other long term conditions
- To gain skills in high quality coding and electronic methods of safety netting within everyday clinical practice.
The module was based on recommendations from a guide first developed in 2015 to improve the quality of coding and safety netting.