ACE Programme projects
Hear about ACE outputs when they become available.
Through NHS England leadership of the programme, access to national policy and development teams will enable common solutions to be built and for commissioning levers, that would otherwise act as a barrier to implementation, to be adjusted (e.g. national tariffs).The different areas being explored will undergo a clinical and economic evaluation by the Department of Health’s Policy Research Units.
Email us if you have any questions about any of the ACE projects - please include the reference number of the project your query relates to.
Lung Cancer Pathway Explores which is the most effective and efficient pathway from referral to diagnosis, including direct access to CT arrangements. Identification and resolution of barriers to implementing best practice will also be explored.
A14 Horsham and Mid-Sussex
The project will develop a new pathway for cancer patients going to Brighton and Sussex University Teaching Hospitals (BSUH), which will involve straight to CT following an abnormal Chest X-Ray.
A16 Nottingham City
Through direct access to CT by GPs, when locally agreed criteria have been met, the project aims to improve 2WW pathway flow and appropriateness of straight to test and one stop clinics referrals.
The projects will complete an audit to review and establish key reasons for delay in presentation with lung cancer as well as develop and implement an integrated and streamlined lung pathway.
A71 Manchester Cancer and The Christie NHS Foundation Trust
The project will perform a data analysis to drive improvement of sectorised model of care, measurement and performance management and define quality standards of lung cancer pathways in Manchester.
A77 North Staffordshire University Hospital
To introduce a system by which abnormal Chest X-Ray automatically triggers a CT scan request by radiologist, GP informed and eGFR requested – to reduce the anxiety of non-cancer patients and improve diagnostic investigation time for cancer patients.
By developing a straight to CT following an abnormal Chest X-Ray pathway, the project has many aims including; promoting joined-up working between primary and secondary care and improving lung cancer survival rates through earlier detection.
Considers approaches for patients that GPs find most difficult to place on a specific pathway, namely those with vague but concerning symptoms; includes exploration of the multi-disciplinary diagnostic centre concept.
A7 Bristol, North Somerset and South Gloucestershire
This acute oncology project which sets out to 1) provide a more efficient pathway for urgent referrals where there is evidence of cancer but no signs/symptoms to suggest the location of the primary cancer (CUP) and 2) develop a service for dealing with patients with vague symptoms where cancer may be a diagnosis amongst other serious diseases.
The project incorporates a Multidisciplinary Diagnostic Clinic (MDC) pilot aims to provide a timely diagnostic pathway for patients with abdominal pain, weight loss or painless jaundice, to improve patient flow and reduce unnecessary admissions for patients with these symptoms.
A38 Airdale, Wharfedale and Craven
The project aims to establish a new electronic referral system from GPs to radiology in order to get triage advice on the most suitable imaging for a patient with suspected cancer who presents with vague symptoms.
A52 Chelsea and Westminster FT
This Acute Diagnostic Oncology Clinic (ADOC), will set up and evaluate a five day direct access service for GPs to refer patients who 1) meet the criteria for a 2ww referral but are unable clinically to wait for the two week referral pathway, or 2) where the GP suspects the patient has cancer but does not know to which site specific team the patient should be referred.
A57 St Helens and Knowsley
The project includes a full CT for suspicious symptoms (CUP) to estimate incidence of suspected MUO cases that are not captured by existing 2WW, test use of CT CAP for this population.
This service evaluation project aims to collect data to evaluate the current diagnostic pathway of teenagers and young adults (TYA) in order to help make improvements to the time to diagnosis, patient experience and inform design of potential interventions.
A70 Manchester Cancer
The Manchester Cancer Jaundice Pathway project will provide earlier diagnosis and timely referral for patients with pancreatic cancer through same-day definitive radiological imaging and fast-track referral for early surgery.
East and West Suffolk CCGs and Hospital Trusts have put in place a simple pathway project to help manage patients with unexplained weight loss. A83 Slough Through retrospective study, the project aims to develop and evaluate a vague symptom referral/risk assessment criteria and a vague symptom diagnostic pathway.
Aiming to develop and evaluate a vague symptom referral/risk assessment criteria and a vague symptom diagnostic pathway.
Explores the impact of using Macmillan electronic Cancer Decision Support Tools on earlier diagnosis and to help identify or flag high risk patients.
A45 London Transforming Services Cancer Team
Prospective audit of cancer diagnoses using the eCDS tool by creating case studies and matching them with staging data.
A29 Tower Hamlets CCG
Development of template to record GP action following consultations using Macmillan eCDS tool to compare resulting cancer diagnoses with historic data/data from practices not using eCDS to ascertain impact on conversion rate of two week wait referrals and stage of diagnosis.
A48 Bridges Medical Practice, Gateshead
Testing the use of Macmillan eCDS tool risk stratification function to identify patients at high risk of cancer within a General Practice in Gateshead and then proactively inviting those patients to visit the GP where advice, referral or diagnostic tests may be offered as appropriate.
A15 Nottingham City CCG
Implementing Macmillan eCDS tool in three CCGs across Nottingham to improve early diagnosis and the appropriateness of two week wait referrals.
Considers which interventions are most effective at driving uptake in different target groups, particularly in high risk and socio-economically deprived communities.
In order to achieve higher bowel screening rates towards the national standard for patients, Practices are chasing non-responders of screening invitation by letter/phone. Each practice will do a search of annual non-responders followed by a monthly search to increase the earlier detection of colorectal cancer.
A17 Nottingham City
The project will raise awareness and improve the uptake of bowel cancer screening, working with local volunteers, targeting low uptake areas/practices linked to deprivation and BME groups.
The project will raise awareness and improve the uptake of bowel cancer screening by working in collaboration with all GP practices, the local council, public health and cancer educators.
A20 Wessex Strategic Clinical Network
The project aims to reduce the inequality in uptake of bowel cancer screening, initially working with those areas and GP Practices with below average uptake. Evidential learning from bowel cancer will be shared across other clinical areas as appropriate.
A29 Tower Hamlet
Through the improvement of systems, processes and IT solutions in primary care, the project aims to increase public awareness of cancer in high risk groups through community engagement, reduce delays in referral and diagnosis and increase uptake of bowel screening.
A30 Manchester Cancer
This is a pilot study exploring primary care involvement in re-engaging patients with the National Bowel Cancer Screening Programme who have previously tested positive on screening but failed to complete colonoscopy.
A34 North, Central & South Manchester
The project aims to use targeted support for GPs to code non-responders to the National Bowel Screening Programme, contacting patients to raise awareness and improve uptake. Non-clinical cancer champions will be the main point of contact for patients, following training and support. A63 Merton Merton CCG is looking to develop a GP endorsement campaign for bowel cancer screening through pre-invitation and follow up for non-responders to improve uptake and raise awareness.
A50/A66 (merged) Cumbria Local Pharmacy Committee and Cumbria
The project aims to use healthy living pharmacies and cancer champions to raise awareness of lung and bowel cancer, including encouraging bowel screening uptake.
A89 Calderdale and Greater Huddersfield
Project members aim to improve the uptake of national bowel cancer screening programmes through personalised communication from GP practices direct to patients.
Focuses on straight to test approaches, best first test and referral thresholds. Such approaches are already being implemented in some parts of the country, so the aim is to gather sufficiently robust evidence to drive pathway spread.
A6 East Midlands Strategic Clinical Network
The project will evaluate the impact of a number of interventions and pathway enhancements to improve the timely diagnosis and experience for urgently referred patients with oesophageal and gastric cancers.
A11 James Paget University Hospital
Project members will aim to reduce patient waiting time from referral to investigation and diagnosis of colorectal cancer by implementing STT flexi sig for appropriate 2WW referrals.
A22 UCL Partners, London Cancer
A quality improvement collaborative has been established to implement STT models of care across member organisations of London Cancer. These models will offer a faster pathway for patients, an effective diagnostic service for GPs and an efficient pathway for Trusts to increase earlier diagnosis of colorectal cancers.
The project aims to provide GPs with a direct access diagnostic service for the referral of patients who have concerning lower GI symptoms, but who do not fit the 2WR criteria, primarily because of age.
A28 Wirral CCG and Wirral University Teaching Hospital NHS Foundation Trust
The project aims to develop an integrated model of care between primary and secondary care, avoiding duplication of clinical consultation, shorten time to diagnosis and MDT discussion, and reduce delays to treatment with no additional investment.
A59 Cambridge & Peterborough CCG
The project is evaluating the existing direct access diagnostic endoscopy service provided by In Health for patients that do not fulfil the 2WW criteria. The service will be evaluated against the service provided by Peterborough Hospital.
A61 Nottingham University Hospital Trust
The University Trust aims to reduce waiting time from 2WW urgent GP referral to investigation and diagnosis of patients referred with colorectal cancer symptoms.
A68 Wrightington, Wigan & Leigh NHS FT
The project will develop a STT service for 2WW suspected colorectal cancer referrals that will enable patients to be booked directly to endoscopy following triage for their diagnostic procedure, reducing waiting times to a maximum of 14 days.
A72 Croydon UHT
The project will provide a ‘one-stop, GP direct access service’ for the diagnosis of rectal bleeding and other high risk symptoms to promote the earlier detection of bowel cancer.
A74 South West Strategic Clinical Network
The project will evaluate the impact of STT approaches for patients with colorectal symptoms in order to develop a sustainable pathway. The project will also test the merging of referral routes to ensure both urgent and routine referrals are simultaneously fast tracked through the diagnostic process to timely treatment.
A79 South West Commissioning Support
In order to streamline the earlier diagnosis of colorectal cancers and ensure faster treatment, the project will pilot a STT electronic pathway that focuses on 2WW and routine referrals based on symptom criteria.
A80 University Hospital of Morecambe Bay
This project will implement a STT diagnostic colonoscopy service for patients referred via the 2WW pathway with colorectal cancer symptoms. The project will exclude patients under 40years and over 75 years of age – these patients would attend regular our patient clinics.
Explores an enhanced role for non-GP primary care professionals in identifying and expediting referral of patients with suspected cancer.
Cancer awareness raising activities through community pharmacies and community pharmacist direct referral to chest x-ray pilot.
A50/A66 (merged) Cumbria Local Pharmaceutical Committee
By using health living pharmacies and cancer champions, the project aims to raise awareness of lung and bowel cancer including encouraging bowel screening uptake
A67 South Tees NHS Foundation Trust
South Tees Optometrist Referral Project (STORP) project aims to pilot direct referral to neuroscience from optometrists in Middlesbrough for people with field vision defects.
Considers which proactive approach provides the most cost effective method of finding undiagnosed early stage lung cancer; one project explores self-referral to chest x-ray.
A33 Manchester, Lancashire and South Cumbria
The project aims to achieve a step change improvement in earlier diagnosis by utilising a risk-stratification process to identify people at highest risk of lung cancer; and then offering them a low dose CT scan as well as targeted smoking cessation advice and support.
The project will raise awareness of respiratory health and illness in communities with high incidence of lung disease and lung cancer. Members of the project will also work with GP practices to risk assess people, and offer low dose CT to those who meet agreed criteria.
A64 Mid Cheshire
The project is focusing on health prevention and promotion of healthy lungs as well as the introduction of a self-request Chest X-Ray service targeted at populations where incidence and mortality is high.
A90 London, University College London (UCL)
UCL’s Health Behaviour Research Centre and Lung’s for Living Research Centre will pilot a lung screen uptake trial across UCLH and Homerton.
A91 Nottingham CCG
This project forms The Rebalancing Foundation which will support vulnerable populations access specialist care to improve lung health in North Nottingham. Areas covered includes lung disease, lung cancer and stop smoking services.
Explores effective ways to remove barriers to screening for a range of vulnerable groups including those with sensory impairment, learning difficulties or minority ethnic groups.
A27 Age Concern Limited, Central Lancashire
The Voluntary, Community and Faith Sector will take a proactive, community based approach to improving diagnosis by engaging with vulnerable groups to raise awareness of screenings and achieve a more efficient pathway and timely diagnosis.
The project will look at whether personal contact from GP practices, to those patients who have failed to attend their 3rd cervical smear invite, will improve uptake.
A47 North East and Cumbria Learning Disability Network in collaboration with the Northern England SCN (Cancer)
The key aim is to reduce the inequality for people with a learning disability accessing screening invitations from the NCSP.
A49 Northern England Strategic Clinical Networks & Cumbria
The project seeks to improve participation in the NCSP across Cumbria, particularly in more vulnerable population groups, by increasing and adapting invitation and follow-up communications using text messaging.
A84 Blackburn with Darwen CCG & East Lancashire
All practices will be required to plan and implement changes that have the potential of increasing uptake of all cancer screening in their patients with learning disabilities.
A85 North Kirklees
The project aims to improve cancer screening uptake in the South Asian community in North Kirklees. Project members plan to raise awareness with the local community groups, communicate findings to GPs and work with practices to improve myth busting with communities.
The five pilots in England that make up the second wave of the ACE Programme are testing multi-disciplinary diagnostic centre (MDC)-based pathways for patients with non-specific but concerning symptoms. All pilots are expected to be live by December 2016.
The ACE Programme plans to pilot a new diagnostic pathway for patients with ‘non-specific but concerning symptoms’ – a pathway which incorporates a Multidisciplinary Diagnostic Centre (MDC).
Patients who display symptoms or a combination of ‘non-specific’ symptoms that indicate several different cancers currently don’t have an effective referral pathway. So, as a result, go back and forth between primary and secondary care, present to emergency services or fall through the gap – which leads to delays to diagnosis and subsequently poor outcomes.
The Independent Cancer Taskforce’s strategy (July 2015) recommends MDCs as an effective way to address this current weakness in the NHS. ACE aims to action this recommendation by testing how feasible this referral route will be for the NHS in England. This pioneering pathway can include several NHS provider organisations involving primary and secondary care.
Pilots form 'Wave 2' of the programme, which aims to test how feasible this referral route will be for the NHS in England - a recommendation outlined in The Independent Cancer Taskforce's strategy (July 2015).
ACE wants to assess how clinically and economically effective an Multidisciplinary Diagnostic Centre (MDC) model would be for England.
With the Wave 2 pilots, ACE will assess MDC’s effectiveness to;
- shift from late to early cancer diagnosis at stages I & II
- reduce the number of emergency presentation diagnoses
- improve patient experience
The Multidisciplinary Diagnostic Centre (MDC) concept comes from Denmark where a patient can undergo several diagnostic tests in one location, at the same time, leading to a faster diagnosis. An MDC doesn’t have to be a new ‘centre’, but can be set up within an existing hospital or community setting and would supplement cancer specific diagnostic pathways.
MDCs can potentially be an effective way to support patients with non-specific symptoms who tend to present late, and support GPs whom are unsure of the appropriate referral pathway.
London Cancer are trialling the concept across five sites, with an MDC-based pathway for a wide range of abdominal and respiratory symptoms. Referral criteria includes patients who cannot wait for a 2WW referral and aims to broaden access to the pathway over time to include self and pharmacy referral.
Two MDCs – physician-led and radiology-led – are being piloted for patients with symptoms including fatigue, weight loss and abdominal pain. Referrals are from GPs only.
A virtual MDC within shared hospital diagnostic resources. The MDC-based pathway is for symptoms including weight loss, anaemia and abdominal symptoms. Possible broadening of pathway to include self-referral.
An MDC-based pathway for symptoms including weight loss, fatigue, appetite-loss and thrombocytopenia. Whole-body CT is the discriminating investigation through primary care triage. Referral is made via GP, Consultant and A&E with a view to expand to self-referral.
Airedale Wharfedale and Craven
An MDC-based pathway for symptoms including recurring abdominal pain and a GP suspicion of cancer with no suitable 2WW pathway. The pilot is oncology-led with electronic referral and triage from GP and A&E.
Each of the 5 MDC projects are developing and testing different approaches to Multidisciplinary Diagnostic Centres (MDC), with the shared aim of increasing the evidence-base for these pathways, and evaluating their clinical and economic effectiveness.
As this work progresses, 3 emerging ‘models’ have been identified, in addition to a set of overarching MDC design principles that identify key elements shared by all 5 projects. These models are not intended to reflect any specific ACE project pathway, but instead provide generic information on distinct potential approaches.
These may change to reflect the Programme’s ongoing learning from the pilot sites, but will be useful in supporting decision-making about potential approaches to developing MDC-based pathways.