ACE Programme Previous Projects

Coronavirus (COVID-19)

We know that this is an especially worrying time so we have created a key messages document for Health Professionals focussed on safety netting patients presenting with symptoms during the coronavirus outbreak. We have also created a page on the subject specifically for patients on our about cancer hub. We will update that information as guidance changes.

Safety netting patients during covid-19

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Explore our current work on the following:

Non-specific symptoms

Lung cancer pathway

The first wave of the ACE Programme was formed by selecting 60 of the most promising early diagnosis proposals from commissioners and providers. Concepts explored included: direct/rapid access to diagnostics; pathways for patients with vague symptoms; and, proactive approaches to identifying high-risk individuals. These approaches had been identified by senior health professionals and researchers as being most likely to improve patient outcomes and experience.

Below you will be able to find information and outputs from these projects over the period 2017/2018, covering: colorectal cancer pathway, bowel cancer screening, electronic decision support tools and pharmacy and other primary care projects. Our work on non-specific symptoms and lung cancer pathway can be found on their own respective pages.

Projects explored ways to streamline diagnostic colorectal pathways.
Findings reveal that improved timely access to diagnostic testing reduces overall waiting times for treatment and improves patient experience.

Executive Summary   Full report

Cluster outputs

Interim Report
Variation in cancer waiting times for lower GI Cancer

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.

A6 East Midlands - Upper GI STT pathway report

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.

A11 James Paget University Hospitals - Virtual clinic summary

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.

A22 Homerton University Hospitals - Direct access flexible sigmoidoscopy GP referral form
A22 Homerton University Hospitals - Direct access to flexible sigmoidoscopy pathway
A22 Homerton University Hospitals - Patient information leaflet
A22 Homerton University Hospitals – Direct access colonoscopy service

A25 Wandsworth
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.

A25 St George’s University Hospitals - STT protocol
A25 Pan London - Suspected lower GI cancer referral form
A25 Pan London - Suspected cancer referral support guide

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.

A28 Wirral University Teaching Hospitals - Virtual clinic pathway

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.

A72 Croydon - Primary care rectal bleeding pathway

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.

A80 Morecambe Bay - GP referral proforma
A80 Morecambe Bay - Colorectal cancer triage criteria

Additional resources

How to guide - colorectal telephone assesment clinic
Guy’s & St T - Colorectal telephone assessment pathway
Guy’s & St T - Colorectal telephone assessment protocol
CNS colorectal telephone assessment competency list
Nottingham University Hospitals – Use of FIT in symptomatic presenting patients

Projects explored ways to improve bowel screening uptake in target groups. The findings reinforce evidence that tailored recruitment strategies improve bowel screening participation, with primary care endorsement a real enabler.

Executive Summary   Full report

A2 Wandsworth
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.

A17 Nottingham City CAS recall project analysis

A18 Luton
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.

A30 Manchester Cancer poster

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.

A47 North East & Cumbria Learning Disability Network first year evaluation

A63 Merton bowel cancer screening project report

PEARL feature in BJC

Projects exploring the use of IT tools to support GPs diagnose cancer earlier. Findings reveal that decision support tools can support clinical judgement; helping to legitimise GPs decisions and raise awareness of cancer symptoms.

Executive Summary

Final using cancer decision report tools report

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.

Projects exploring roles of non-GP primary care in early diagnosis. Project summaries contain benefits and challenges faced by expanding the roles of pharmacists and opticians. Suggestions for improvement are also included.

Cluster Outputs

Pharmacy training for early diagnosis of cancer (updated June 2017)
Optical referral pathway summary

A1 Doncaster
Cancer awareness raising activities through community pharmacies and community pharmacist direct referral to chest x-ray pilot.

Doncaster pharmacy to CXR project summary

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.

Cumbria GP referral form

Cumbria patient consent form

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.

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Last reviewed

This report provides an overview of the 60-project portfolio that formed wave 1. It draws out key themes and highlights from the main body of work and is aimed at healthcare professionals who take a strategic view of cancer service improvements.

A report from the wave 1 projects - September 2017