How to do the NCDA

Man at computer

Get involved

English GP practices can register for the National Cancer Diagnosis Audit 2019 using the link below.
Register for NCDAScottish practices can register by emailing:

NSS.isdncda@nhs.net

The next round of the NCDA has now started. Data collection will be on an ongoing basis over a 12 months period to allow more flexibility than in previous audits. Feedback will be provided to practices at two points (interim report and full report).

The timelines for the NCDA 2019 are as follows:

  Registration start Data collection start Feedback: Interim reports Feedback: Full reports
England Feb 2019 Apr 2019 Nov 2019 May 2020
Wales Sep 2019 Oct 2019 May 2020 Nov 2020
Scotland Jun 2019 Aug 2019 Feb 2020 Aug 2020

For more information on how to register in England, download our step-by-step guide to audit registration.

For more information on how to register in Scotland, download our step-by-step guide to the Scottish NCDA.

Collecting the data

GPs have fed back that collecting data on a single patient for the NCDA took approximately 15 to 20 minutes. But this will vary with patient complexity, the clinical system used, and familiarity with the NCDA data form.

The number of patients records that need to be completed varies depending on practice size and patient population. An average practice with list size 10,000 can expect approximately 5 patients per month, which will mean a time commitment of just under 2 hours per month, which may be split between multiple GPs at the practice.

No, the data for the next NCDA will be collected on an ongoing basis. You can input data on patients as they come through, or you can submit data in installments or all at once at the end of the data collection period.

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 sufficiently 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 our audit time period (this varies for each nation), 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 and Wales, patients are identified by the English registry (NCRAS) or Welsh registry, respectively, and made available to the GP practice via an online portal. 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) are not included in the audit. Such patients may be present in your list of eligible 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 record this on the data form under ‘Screen detected patient’. You won’t have to complete the other data items for such patients.

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 in England and Wales will need to complete the audit in a location that has a secure 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 and the NCDA 2014, updated where needed. While creating the data collection systems user testing was completed, to make sure that this data collection is as easy for practices as possible.

GPs in England and Wales 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 or wales.nhs.uk 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.

In England and Wales, data will be collected via a specifically designed data collection system (the NCDA portal). More information on how to access this system will be made available when the audit launches.

In Scotland, data will be collected on Excel spreadsheets sent to the practice by ISD Scotland.

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 

The audit team provides confidential, tailored feedback reports to all participating practices. 

In England, feedback will also be available at CCG, Cancer Alliance and STP levels if participation in the local area is high enough to allow creation of such reports.

In Wales and Scotland, feedback will also be available at Health Board level if participation in the local area is high enough to allow creation of such reports.

Tailored practice reports issued to all participating practices compare practice averages to the national average, as well as a cluster of similar practices (where possible) and regional averages (e.g. CCG or Health Board levels). Data presented in practice reports include:

  • Place of first presentation
  • Time from presentation to referral
  • Number of pre-referral consultations with GP
  • Use of primary care-led diagnostic tests
  • Types of referrals, incl. detailed breakdown of emergency referrals
  • Summary of avoidable delay data
"The practice reports produced were excellent and a valuable tool for discussion at both practice and cluster level. We aim to repeat the audit again for all of our cluster practices this year.” – GP from Glasgow
"The report was surprising in some ways, and undoubtedly practice-changing.” GP from Caterham

Tailored CCG, Cancer Alliance, STP, and Health Board can be made available where participation levels are high enough to ensure that individual practices are not identifiable from reports (as the audit is not used for performance management).

Data presented in these reports include:

  • Place of first presentation
  • Time from presentation to referral and diagnosis
  • Number of pre-referral consultations with GP
  • Use of primary care-led diagnostic tests
  • Types of referrals, incl. detailed breakdown of emergency referrals
  • Summary of avoidable delay data

Patient consent and information security

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