It could easily be misunderstood that the role of the GP is to protect secondary care from referral workload, yet this case highlights Suspected Cancer Guidance on Unintentional weight loss, Anaemia and Thrombocytosis in male smokers- an accumulation of risk factors that pushes the Positive Predictive Value above the threshold for Urgent Suspected Cancer referral. 

Since the PPV threshold of 5% was reduced to 3% GPs have embraced greater access to diagnostics in an attempt to improve Cancer Outcomes and early-stage diagnoses, which presents the challenge of interpreting non-specific symptoms and vague presentations.

The case highlights cumulative risk that each factor considered separately would not meet the threshold for referral. There are mitigating factors to further offer alternative explanations as to the cause of the symptoms. 

Further investigations would extend the Primary Care Interval (between the first presentation to the GP to the point at which a Suspected Cancer Referral is made) which is reviewed within the National Cancer Diagnosis Audit. Rapid Access Non-Specific Symptom Clinics have been created to receive referrals on vague symptoms and co-ordinate rapid course of investigations to exclude cancers, liaising with onward care in the event of Cancer or other significant non-Cancer diagnoses