- Design
- Cross-sectional, practice-level mixed-effects regression
- Population
- 3,053 English general practices; 31.2 million online triage forms
- Primary outcome
- Cancer referral, investigation and diagnostic outcome indicators
- Effect
- Colonoscopy rate +7.75 points (3.83–8.98); no association with conversion or emergency presentation
This BJGP cross-sectional study linked more than 31 million online triage forms from 2022–23 to publicly reported cancer indicators for 3,053 English general practices.
Practices that received more online triage forms per registered patient made more urgent suspected cancer referrals and requested more investigations — for example, about 7.75 percentage points more colonoscopy across the middle 90% of practices. But there was no association with the proportion of those referrals that led to a cancer diagnosis, or with emergency cancer presentations.
At practice level, then, more digital access meant more referrals without more cancers detected, which the authors read as a possible fall in referral quality. It is an ecological association, not a judgment on any individual consultation, but it is a reason to keep clinical reasoning — not the form — in charge of the referral decision.
- Review online triage submissions with the same clinical judgment as a face-to-face history.
- Bring patients in for examination when an online form raises a possible cancer symptom.
- Check that urgent referrals meet the criteria rather than being driven by how a form was completed.
- Keep safety-netting explicit for patients managed entirely online.
Why it matters
Digital front doors may be shifting referral volume without improving the cancers caught.
Don't overread it
This is a practice-level association and cannot show that online triage caused poorer referrals.
The statistics, in plain English
Comparing practices in the middle 90% of online triage use, the busiest users had a colonoscopy rate 7.75 points higher (95% CI 3.83 to 8.98). No matching rise in diagnostic yield suggests the extra tests found little extra cancer.
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