Insights & Quality Improvement

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Download the RCGP CRUK QI Toolkit for earlier cancer diagnosis to support 

Read the toolkit

Cancer Research UK supports GPs to use local data to understand what the opportunities for quality improvement are and offers free, tailored support for their quality improvement activities.

Data from the National Cancer Diagnosis Audit (NCDA) helps us to better understand how cancers are diagnosed. The audit has shown that:

  • GPs are the first port of call for the majority of patients with signs and symptoms that could be cancer
  • Most patients are referred to a specialist promptly (after only one or two consultations)
  • There are patients who experience avoidable delays in receiving their diagnosis, and those with non-specific symptoms are more likely to experience delays

The audit helps practices identify areas for improvement. It has already led to changes to referral behaviours, follow-up processes, use of safety netting, and other activity related to cancer diagnosis. These changes drive improvements in care and help diagnose cancer earlier.

The NCDA has a strong quality improvement (QI) component and encourages practices to use the audit results to inform targeted QI activity. National cycles of the NCDA provide all participating GPs with a tailored feedback report on their practice’s data to support QI planning.

The report:

  • Highlights examples of good practice
  • Identifies potential areas for further review
  • Helps decide where to focus quality improvement activity
  • Identifies variations at practice level
  • Provides comparative information, as well as criteria and standards for benchmarking
  • Suggests next steps and signposts to support and relevant QI resources

Many GPs undertake quality improvement activities based on insights from their NCDA report, as well as learning gained while auditing individual cases. Most often, these activities focus on improving referral behaviours, safety netting and cancer screening uptake.  


In England, the NCDA can also support PCN-level work on early cancer diagnosis.

The Cancer Research UK and Royal College of General Practitioners’ QI Toolkit for the Early Diagnosis of Cancer was specifically developed to support QI planning.

The most recent findings available from the audit, looking at new cancer diagnoses in 2014, showed:

  • Co-morbidity burden is high among patients diagnosed with cancer
  • The majority of patients first present at the GP surgery (or have a home visit)
  • Many patients have primary care-led investigations, such as blood tests and imaging, before they are referred
  • Many patients are still diagnosed through routes other than an urgent suspected cancer referral / two week wait pathway
  • Patients with vague symptoms are more likely to be diagnosed as an emergency and with a late stage cancer
  • Use and recording of safety netting varies by practice and by cancer type
  • For more than one in five patients, GPs in the audit considered there to have been an avoidable delay in the patient receiving their diagnosis
  • Patients with non-specific but concerning symptoms are more likely to experience an avoidable delay

National findings from the previous cycle of NCDA have been presented in academic papers (see publications in the accordion below and at conferences. These will act as a baseline to monitor implementation and impact of NICE NG12 cancer referral guidelines when analysed alongside findings from the most recent cycle of NCDA, which looked at cancers diagnosed in 2018.

Primary care blood tests before cancer diagnosis: National Cancer Diagnosis Audit data
Pre-Referral Primary Care Blood Tests and Symptom Presentation before Cancer Diagnosis: National Cancer Diagnosis Audit Data
The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit


National Cancer Diagnosis Audits for England 2018 versus 2014: a comparative analysis


Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit (England) - British Journal of General Practice


The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients (England) - Cancer Epidemiology


Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study (England) - The Lancet Oncology


Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms (England) - BMJ Open


Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit (Scotland) - European Journal of Cancer Care


Impact of geography on Scottish cancer diagnoses in primary care: Results from a national cancer diagnosis audit (Scotland) - Cancer Epidemiology


Morbidity and measures of the diagnostic process in primary care for patients subsequently diagnosed with cancer – Family Practice

Read the full paper (link is external)

The prevalence of chronic conditions in patients diagnosed with one of 29 common and rarer cancers: A cross-sectional study using primary care data – Cancer Epidemiology

Read the full paper (link is external)

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