A pilot enabling community pharmacists to refer patients with suspected cancer symptoms directly to their GP or hospital has led to the identification of one confirmed cancer and one pre-cancerous condition, highlighting the potential role of community pharmacy in supporting earlier cancer diagnosis.
Background
The initiative supports the national ambition, set out in the NHS Long Term Plan, for 75% of cancer patients to be diagnosed at stage one or two by 2028. Community pharmacies were identified as a promising way to help achieve this goal. This is particularly true in areas of higher deprivation, where they may play an important role in reducing inequalities in cancer diagnosis.
The South East Cancer Alliance (SELCA) signed up to the NHS England National Community Pharmacy Referrals for Suspected Cancer Pilot in 2023, with the service launching in May 2024 across 15 pharmacies in Lambeth and Southwark. Participating pharmacies could refer patients to primary care for five suspected cancer types (skin, breast, haematology, and upper and lower gastrointestinal), while four further tumour groups (head and neck, gynaecological, urology, and lung) went via direct secondary care pathways. A direct chest x-ray referral route for suspected lung cancer went live in January 2025.
SELCA extends the pilot
The pilot was originally funded by NHS England between May 2024 to June 2025and was subsequently extended by SELCA from July 2025 for a further nine months. During the extension, SELCA worked closely with the Pharmacy Alliance and the NHS Midlands and Lancashire Commissioning Support Unit to continue delivering the pilot and onboard five additional pharmacies.
How was the evaluation conducted and what data was collected?
The evaluation drew on several sources, including a structured survey completed by 13 of the 16 participating pharmacies, in-depth interviews with lead contacts from eight pharmacies, telephone interviews with eight referred patients, and a clinical outcomes dataset tracking patients following referral.
Key findings
During the full pilot period, from May 2024 to March 2026, pharmacies made 74 referrals in total: 68 to primary care and six directly to secondary care. Skin complaints accounted for the largest share of referrals (59%), followed by breast (11%) and lung (8%).
During the SELCA-funded extension, 30 patients identified by pharmacists were tracked through to a clinical outcome. Of these, 10 were seen in secondary care. The results included:
- One confirmed cancer diagnosis - a 77-year-old man was referred after presenting with an irregular lesion on his forehead and was subsequently diagnosed with a Stage 1 squamous cell carcinoma, a form of skin cancer. He underwent a surgical excision.
- One pre-cancerous finding - a 68-year-old woman was referred with a skin concern and diagnosed with actinic keratosis, a pre-cancerous skin condition, and referred on for an excision.
The remaining eight secondary care referrals returned benign or showed no evidence of cancer. Referrals were typically processed quickly, with a median of four days between a pharmacy consultation and the referral reaching hospital, and a further seven days to a clinical outcome.
Despite these positive findings, referral volumes remained modest overall and the evaluation concluded that current numbers were not sufficient to justify extending the pilot further. Whilst the pilot demonstrated that community pharmacists can identify patients requiring further investigation and help reach more deprived populations, overall referral volumes remained modest. The evaluation therefore concluded that the activity generated was not sufficient to support continuation of the pilot in its current form.
Who did the pilot reach?
Patients referred through the scheme were broadly split between men and women, with the majority aged over 60. The ethnicity data was incomplete for many records, which was recognised as a limitation of the evaluation. Deprivation was a notable feature of the cohort. the Index of Multiple Deprivation scores showed that half of all patients lived in areas of moderate-to-high deprivation, and every patient who went on to be referred into secondary care came from an area of at least moderate deprivation. This supported the idea that pharmacies can help reach people who face greater barriers to accessing GP services.
What's next
While the pilot itself will not continue in its current form, the findings reinforce the potential of community pharmacies as a trusted, accessible "front door" into cancer pathways, particularly for people who might otherwise delay seeking help. Lessons on training, technology and public awareness are included in the evaluation report to inform how any future, larger-scale version of the service could be designed.