How to do the audit

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Get involved

England register here

(NHS internet connection and firewall required)

Scotland register here

How the audit will work in practice, the time commitment involved, when the audit data collection period is, who from the practice can get involved, and the support available to practices during and after the audit.

Collecting the data

Collecting data on a single patient took 15 minutes during the pilot study. This will depend on patient complexity, clinical system navigation ease and internal support availability. Each GP can expect around 8 cancer diagnoses, making the average time commitment around two hours per GP.

The data collection period will last for a 3 months. You can input data on all patients at once or in multiple instalments and submit once.

It is up to each practice how they decide to take part in the audit – whether all GPs review their own patients, whether they review each other’s’, or whether one GP leads on this on behalf of the others.

GPs registrars and medical students may complete the audit on behalf of the practice. The supervising GP will need to oversee and quality assure their work in order to ensure accurate data extraction and to maximise any practice learning opportunities during and following the audit. Anyone accessing the data from the cancer registries will need to satisfy the verification process requirements.

If a practice wishes to delegate the data collection to a non-clinical colleague, they will need to be satisfied that the individual concerned has good knowledge of medical terminology and is sufficient trained to review clinical notes. There are some areas of the audit where we have specified that only a GP can respond (where clinical judgment is required).

We are asking practices to undertake the data collection on all patients registered to the practices that were diagnosed in 2014 regardless of potential use of private diagnostic care or treatment and regardless of referral or diagnostic route.

Non-melanoma skin cancer and non-malignant tumours (ICD-10 C44) will be excluded from the patient list returned to GPs.

In England, patients will be identified by the English registry (NCRAS) and given to the GP practice. In Scotland, patients will be identified by the Scottish registry (NHS National Services Scotland) and transferred to the practice.

Patients whose cancer is recorded by the cancer registry as being detected via one of the national screening programmes (breast, cervical and bowel) will be present in your list of patients, but you will not need to complete primary care data for these patients.

There may be a small number of cases, mainly bowel and possibly cervical, where the cancer registry does not have a record of the cancer being screen detected. Where you know this, please contest the registry data and say the cancer was detected via screening, and complete all other data fields as ‘not applicable’.

Practices will have 3 months to complete the data collection:

  • England: September - January 2017
  • Scotland: January - March 2017

GPs will need access to their clinical system to complete the audit, and they will need to comply with their Information Governance good practice requirements. GPs will need to complete the audit in a location that has a N3 internet connection (connected to the NHS internet, behind the NHS firewall) to satisfy Public Health England’s data security requirements.

The data specification was informed by that of the 2009/10 National Audit of Cancer Diagnosis in Primary Care*, updated where needed. Furthermore, a pilot was undertaken to shape the data collection processes. While creating the final data collection system user testing will be completed, to make sure that this data collection is as easy for practices as possible.

*http://www.rcgp.org.uk/policy/rcgp-policy-areas/national-audit-of-cancer

GPs in England taking part in the audit will need access to their own clinical system, and be able to access the data collection portal through a N3 internet connection (connected to the NHS internet, behind the NHS firewall).

GPs and practice staff will need to access an NHS.net email in order to register and successfully complete the GP verification processes. Computers must have an internet browser of Internet Explorer 8 or above to access the online portal.

In Scotland GPs taking part in the audit will need access to their own clinical system and access to their own nhs.net email address.

We are seeking information on:

Patient characteristics; ethnicity, communication difficulties, living arrangement, language competency, housebound status and co-morbidities. Symptoms, test results and investigations ordered. Date of referral, type of referral and number of referrals. Avoidable delays in patient pathway. Place and date of first presentation, number of consultations, safety netting, the date a patient was seen by specialist and the data a patient was told they had cancer.

This is a short video of the online data collection portal that demonstrates how easy it is to use.

A practice can register via this website or via https://nww.canceraudit.phe.nhs.uk. In the first instance a GP needs to register so they can be verified to protect the patient identifiable data. Once the GP has logged into the portal, the GP can add other users at the practice. Each other user will be sent their own login details and will see the same practice list of patients.

Once a GP has registered the emails they receive from the portal will take them step by step through what they have to do. First they will confirm their email address, they will then be told that their details are being verified and that login details will be sent to them shortly.

Once the first GP has logged in, they will be able to add other users (other GPs, clinical or non clinical staff) within the practice who will all be sent separate log in details. Other users will be able to then login independently, view all the patients and collect and input the audit data into the portal.

Audit outputs

Completing the audit allows practices to reflect on their clinical practice and practice based systems and processes. Specific insights may include:

  • Types of delay
  • Where delays occur
  • Factors contributing to multiple consultations
  • Impact of patient characteristics
  • Overview of presenting symptoms by key tumour types to highlight complexities
  • Presenting symptoms by place of presentation
  • Identification of good practice 

Feedback will be available at a practice and CCG level in England, as well as national. In Scotland the feedback will be available at a practice and Health board level.
 

Potential case by case feedback

In England the data collection portal will aim to flag:

  • Patients who have an emergency diagnosis referral type
  • Patients who died in under 30 days after their diagnosis date
  • Patients with screenable cancers (and age group) who were diagnosed at late stage
  • Breast cancer, female, aged 50-70 years old
  • Bowel cancer, aged 60-74 years old in England, Wales and Northern Ireland, 50-74 years old in Scotland
  • Cervical cancer, female, aged 25-64 years old in England, Wales and Northern Ireland, 20-60 years old in Scotland
  • Patients with cancer that did not undergo any GP investigations but had 3+ consultations prior to referral

 

Comparison against national average

In England and Scotland this will compare practice averages to the national average and show the difference from the average (similar to GP profiles, difference will be reported as high/low/not significantly different).

  • Time from presentation to diagnosis
  • Number of pre-referral consultations with GP
  • The number of primary care made referrals per patient before diagnosis
  • The number of primary care led investigations per patient before diagnosis
  • What proportion of patients were referred on the urgent referral pathway
  • What proportion of patients over 60 were referred on the urgent referral pathway
  • What proportion of patients diagnosed with lung, prostate and ovarian cancer had a chest X-ray, PSA level or CA125 level (as appropriate) undertaken in primary care after their first presentation and before diagnosis

Information on their area

  • How many member practices participated
  • What size population the findings covered

 

Comparison against national average

Data will then be feedback to CCGs as an average across the CCG, to be compared to national average and suggested standards. The feedback will only be given to a CCG if an adequate number of practices participate with required data quality. CCGs with low numbers of participating practices will not receive this feedback. 

  • Time from presentation to diagnosis
  • Number of pre referral consultations with GP, broken down by tumour site (combining rare cancers)
  • The number of primary care made referrals per patient before diagnosis, broken down by tumour site (combining rare cancers)
  • The number of primary care led investigations per patient before diagnosis, broken down by tumour site (combining rare cancers)
  • What proportion of patients diagnosed with lung, prostate or ovarian cancer had a chest X-ray, PSA level or CA125 level (as appropriate) undertaken in primary care after their first presentation and before diagnosis.

Information on their area

  • How many member practices participated
  • What size population the findings covered

 

Comparison against national average

Data will then be feedback to health boards as an average across the health board, to be compared to national average and suggested standards. The feedback will only be given to a health board if an adequate number of practices participate with required data quality. Health boards with low numbers of participating practices will not receive this feedback. 

  • Time from presentation to diagnosis
  • Number of pre referral consultations with GP, broken down by tumour site (combining rare cancers)
  • The number of primary care made referrals per patient before diagnosis, broken down by tumour site (combining rare cancers)
  • The number of primary care led investigations per patient before diagnosis, broken down by tumour site(combining rare cancers)
  • What proportion of patients diagnosed with lung, prostate or ovarian cancer had a chest X-ray, PSA level or CA125 level (as appropriate) undertaken in primary care after their first presentation and before diagnosis

Section 1: Dataset characterisation
1.1    Characterise reported disagreements in data between registration data and primary care
1.2    For each field tabulate the fraction data items complete; missing; and invalid (if relevant)
1.3    Compare final tumour/patient cohort to full 2014 cancer registration cohort
1.3.1    Variation by sex; age ; cancer type; stage; survival time

Section 2: Interval length & consultations
2.1    Interval lengths (presentation to referral; referral to specialist visit; total) variation by:
2.1.1    sex; age ; cancer type; stage; survival time; 
2.1.2    language; communication; housebound status and other patient factors
2.1.3    symptom
2.1.4    investigations
2.1.5    referral type; multiple  referrals; referral speciality 

2.2    Consultations (number and type of consultations) by:
2.2.1    sex; age ; cancer type; stage; survival time
2.2.2    language; communication; housebound status and other patient factors
2.2.3    symptom
2.2.4    investigations
2.2.5    referral type; multiple  referrals; referral speciality 

Section 3: Investigation prior to referral
3.1    Characterise investigations including variation by:
3.1.1    sex; age ; cancer type; stage; survival time
3.1.2    language; communication; housebound status and other patient factors
3.1.3    consultations
3.1.4    symptom
3.1.5    referral type; multiple  referrals; referral speciality 

Section 4: Comparison of referral pathway
4.1    Characterise referral type (including multiple referrals and speciality) by:
4.1.1    sex; age ; cancer type; stage; survival time
4.1.2    language; communication; housebound status and other patient factors
4.1.3    consultations
4.1.4    symptom
4.1.5    investigations

4.2    Compare referral type as recorded by GP to that recorded centrally and tabulate difference by:
4.2.1    referral type; multiple  referrals; referral speciality 
4.2.2    sex; age ; cancer type; stage; survival time
4.2.3    language; communication; housebound status and other patient factors
4.2.4    consultations
4.2.5    symptom
4.2.6    investigations

Patient consent and information security

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Email the team for more information or any queries.

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GPs from Wales and Northern Ireland who are interested in getting involved should contact the team

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