NCDA overview

Doctors discussing notes

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 National Cancer Diagnosis Audit (NCDA) looks at primary and secondary care data relating to patients diagnosed with cancer. It helps us to understand pathways to cancer diagnosis, what works well and where improvements could be made.

The audit looks specifically at clinical practice in order to understand:

  1. interval length from patient presentation to diagnosis
  2. use of investigations prior to referral
  3. what the referral pathways for patients with cancer are and how they compare with those recorded by the cancer registry

The next round of the NCDA has now started. GP practices in England and Scotland can sign up now, GP practices in Wales from August. 

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.

Secondary care services regularly submit data about cancer waiting times and cancer treatments & outcomes to cancer registries in the UK. This helps us to understand patient pathways from referral through diagnosis to treatment and beyond. For most patients, however, their cancer journey starts with a visit to their GP, but there is no routine national data collection that looks at this part of patient pathways. 

The National Cancer Diagnosis Audit (NCDA) seeks to fill this gap by collecting data on patient pathways through primary care to referral and cancer diagnosis. This helps us to understand the pivotal role that primary care plays, the challenges GPs face in diagnosing cancer early, what good practice exists, and where improvement initiatives could have the most impact.

The first ever National Audit of Cancer Diagnosis in Primary Care was completed in England in 2010, followed by a second audit in 2016/17 in England and Scotland. Both audits:

  • provided evidence of the crucial contribution of primary care to cancer diagnosis
  • generated influential evidence about the size and nature of the challenge of cancer diagnosis in primary care
  • informed quality improvement (QI) activities at practice level and beyond
  • provided evidence for GP revalidation and appraisal, as well as CQC inspections
  • supported the development and/or evaluation of national policies and initiatives, such as referral guidelines, optimal pathways and multi-diagnostic centres

The NCDA is referred to in Achieving World Class Cancer Outcomes‘: a strategy for England 2015-2020’ which highlighted the critical role of national clinical audit in driving improvement.

In early 2019, NHS England published their Five Year Framework for GP Contract Reform. In this, they committed to ‘develop a QOF Quality Improvement module for national use [in England] in 2020/21 to help practices and networks understand their own data, and work through what they can do to achieve earlier diagnosis’ (Section 6.28, page 46). Taking part in NCDA in 2019/20 will provide GPs with valuable insights into pathways to cancer diagnosis to inform impactful, targeted quality improvement in future. And continuous rounds of the NCDA will support ongoing QI activity at practice level and beyond.

 

The cancer registration services, which routinely collect hospital data on all cases of cancer, will allow GPs access to data from their patients who were diagnosed with cancer during the timeframe selected for the audit.

Participating GPs will then securely submit information about the primary care part of the pathway for these patients. Information will be collected from the period of a patient first presenting with symptoms to their diagnosis, including on: consultations, key dates, investigations, symptoms, referrals, and some patient characteristics.

The NCDA data will be analysed centrally for free and each GP practice will receive a confidential, tailored feedback report. Higher level reports (incl. CCG, Health Board, Alliance and other reports) will also be made available where possible.

Information governance and data release requirements will be met. The data may be used in future for further audit and research purposes. However, appropriate approvals will be sought for any further research and any data made available for research will not include patient, GP or practice-identifiable information.

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), NHS England and NHS National Services Scotland.

Right from the start, the National Cancer Diagnosis Audit team have worked with patient representatives to ensure the audit is informed by the views and experiences of cancer patients. We have at least two patient representatives on our steering group for the audit. Currently we are working with John and Jennifer, who are part of our UK-wide steering group, as well as Austin, who is our patient representative in Scotland.

Previously, our patient representative Sue provided invaluable insights to help develop the audit from the outset.

Read about Sue's experience

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 looked at patients diagnosed with cancer in 2014, and collected data on 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)[1] and so will act as a vital benchmark against which 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[2].

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 learning event analysis (LEA) 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 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[3] 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[4]. 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

  1. NICE Guidance: Suspected Cancer: recognition and referral
  2. International Cancer Benchmarking Partnership
  3. CRUK National Cancer Diagnosis Audit
  4. Improvement in patient outcomes – survival by stage

The next National Cancer Diagnosis Audit has now started in England and is due to begin in Scotland and Wales soon. Your help in raising awareness locally and promoting participation is much appreciated. The below resources may be used to support this activity.

NCDA At a Glance (England)

NCDA Flyer for GPs (England)

NCDA Flyer for CCGs and Cancer Alliances (England)

Other resources will be made available here in future.

Email the team for more information or any queries.

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