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The National Cancer Diagnosis Audit (NCDA) uses primary and secondary care data relating to patients diagnosed with cancer and will start this year by looking at cases diagnosed in 2014. This will help us understand patterns of cancer diagnosis for all cancer types, across the UK prior to the 2015 NICE guidelines for suspected cancer referral, so that in time, we can assess the impact of the new referral guidelines.
The audit looks specifically at clinical practice in order to understand:
- interval length from patient presentation to diagnosis
- use of investigations prior to referral
- what the referral pathways for patients with cancer are and how they compare with those recorded by the cancer registry
The first National Cancer Diagnosis Audit in primary care was completed in England in 2010, involving 1,170 practices and data from 18,879 patients from 20 Cancer Networks. The audit process and results motivated repeatable cycles of quality improvement activities (such as Significant Event Audit activity), generated influential evidence about the size and nature of the challenge of cancer diagnosis in primary care and led to the development of a suite of audit tools that have been utilised since to support local service improvement initiatives.
The 2016 National Cancer Diagnosis Audit is referred to in Achieving World Class Cancer Outcomes‘: a strategy for England 2015-2020 identified the critical role of national clinical audit in driving improvement. This audit will collect data from all UK nations, the data will be analysed against standards from NICE and the 2015 England cancer strategy.
This National Cancer Diagnosis Audit will:
- Produce a vital benchmark prior to the 2015 updated NICE (National Institute for Health and Care Excellence) urgent referral guidelines for suspected cancer from patients diagnosed in 2014
- Develop an approach that supports a sustained programme of clinical audit of cancer diagnosis for a 3 to 5 year period
- Enable measurement of key aspects of the cancer strategies in the UK nations
- Link primary care data to definitive secondary care data on cancer type, stage and date of diagnosis across countries in the UK
- Help identify the most efficient use of heath care resources
- Ultimately enable earlier diagnosis of cancer, improving outcomes
The cancer registration service, which routinely collects hospital data on all cases of cancer, will allow GPs access to data from all of their patients who were diagnosed with cancer in 2014.
Participating GPs will then securely submit information gathered on their patients. Information will be collected from the period of a patient first presenting with symptoms to their diagnosis, including: consultations, key dates, investigations, symptoms and referrals. Information will also be collected on patient characteristics such as ethnicity, reasons why patients might find it difficult to communicate with a GP, attend the GP surgery and other health conditions.
Information from England, Scotland, Wales and Northern Ireland will be combined at Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and analysed centrally. Analysis will be performed to allow feedback regarding diagnostic pathways and multiple referrals at a national and local level.
Information governance and data release requirements will be met. Information will be transferred securely between GPs and the cancer registry. The data may, in the future, be used for further audit and research purposes. However, appropriate approvals will be sought for any further research.
The Cancer Research UK healthcare professional engagement (HPE) facilitators, Cancer Research UK and Macmillan GP leads will support GPs in the collection and submission of data. . In order to maximise local learning the HPE facilitators will work closely with practices when reviewing feedback.
This National Cancer Diagnosis Audit is being operationally managed by Cancer Research UK, but is a broad partnership that involves support and input from: The Royal College of GPs, Macmillan Cancer Support, Public Health England (specifically the National Cancer Registration and Analysis Service) and NHS England.
Sue is one of the patients who has provided invaluable insights to help develop the audit.
We are aiming to recruit 10% of practices to this audit. Your help in raising awareness locally and promoting participation is much appreciated.
NCDA external briefing (slides) available on request
The National Cancer Diagnosis Audit is a bold programme to assess the routes to diagnosis for our patients who are diagnosed with cancer by bringing together the cancer registry record with the primary care information in a new way. It is hoped that by having engagement of a good representation of Practices from all quarters of the UK a broad picture will develop as to what is being done well, and where there is room to improve our clinical practices, diagnostic pathways, the link between primary and secondary care and, ultimately, improve the outcomes of our patients.
The initial audit will involve patients diagnosed with cancer in 2014, and will look at the patients’ presentation, investigations and onward referral leading to a diagnosis of cancer. This was the last full year prior to the introduction of the new NICE Guidance for Suspected Cancer (NG12) and so will act as a vital benchmark against wish to assess future change.
Undertaking the audit will facilitate reflection of the patients’ management and may lead to further discussion with colleagues as to what went well and what could be done more effectively in the future and whether there is a case for doing things differently within your practice. The project will bring with it benefits for the auditing GPs, the practice and crucially your patients. In addition, you will be contributing to a unique national programme that could influence the delivery of care both in the UK and further afield through analyses developed though UK research groups and the International Cancer Benchmarking Partnership.
The exercise will contribute to your CPD activities, and your appraisal and revalidation processes. The intention is for the audit to be an ongoing programme, which will then help evaluate the impact of undertaking the audit, the adoption of the NICE Guidance, and the changes made following the role out of the new cancer plans adopted across the four Nations in the years to come. Practices will have patients that are good candidates for a significant event analysis (SEA) flagged and will receive analysis on their data, comparing the practice intervals, consultations and investigations against the national average.
The programme is being run through a collaboration of the Royal College of General Practitioners, Cancer Research UK, Macmillan Cancer Support, the National Cancer Registration and Analysis Service (PHE) and NHS E committed to delivering it as one of the recommendations of the new Cancer Strategy for England. Your local CRUK and Macmillan GPs and facilitators will be able to give you further information, or alternatively there are FAQ on the CRUK website.
All those involved with the planning and implementation of the audit are acutely aware of the incredible pressures faced by General Practice on a daily basis, however we believe that engagement with this programme will be both interesting and stimulating. Previous research has shown that engaging in such activity results in a statistically significant improvement in patient outcomes. The audit has the potential to impact upon our patients, wider societies and beyond. I am reminded that in my medical school application all those years ago, one of the reasons I chose medicine as a career option was to “make a difference”, and it is likely that many others’ personal statements carry a similar desire. Engaging in this audit will be one such opportunity, and I would personally encourage you to discuss enrolling with your colleagues, and join, what I’m sure will be an influential project.
Dr Richard Roope, RCGP & Cancer Research UK’s Cancer Champion
Email the team for more information or any queries.
GPs from England, Scotland and Northern Ireland who are interested in getting involved in future audits should contact the team