NCDA overview

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English GP practices can now register for the National Cancer Diagnosis Audit 2019 through the link below.
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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 is due to begin in 2019. GP practices in England will be able to register from Monday 18th of February, GP practices in Scotland from May and GP practices in Wales from July. If you are a GP based in England, you can now register for the next round of the audit. For more information on how to register, download our step-by-step guide to audit registration.

The first National National Audit of Cancer Diagnosis 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.

Since then, a second audit was carried out in 2016/17 looking at patients diagnosed in 2014. The National Cancer Diagnosis Audit (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.

Learning from the last round of the NCDA will inform future rounds of this audit. This will enable monitoring of changes in pathways, and of the impact of practice- and local-level quality improvement activities, as well as national service innovations and guidelines.

This National Cancer Diagnosis Audit:

  • Enables measurement of key aspects of the cancer strategies in the UK nations
  • Links primary care data to definitive secondary care data on cancer type, stage and date of diagnosis across countries in the UK
  • Helps identify the most efficient use of heath care resources
  • Supports ongoing learning and quality improvement in primary care and beyond
  • Ultimately will enable earlier diagnosis of cancer, improving outcomes for patients and families

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

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 reasons why patients might find it difficult to communicate with a GP, attend the GP surgery and other health conditions.

Information 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 practice, local, and national levels.

Information governance and data release requirements will be met. Information will be transferred securely between GPs and the cancer registries. The data may also be used for further audit and research purposes. However, appropriate approvals will be sought for any further research.

The Cancer Research UK facilitators, as well as Cancer Research UK and Macmillan GP leads, will be available to offer advice and support for participating GPs in the collection and submission of data. In order to maximise local learning the 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), 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.

Sue was one of the patients who provided invaluable insights to help develop the audit from the outset.

Read about Sue's experience

The next National Cancer Diagnosis Audit is due to launch from spring 2019. Your help in raising awareness locally and promoting participation is much appreciated. The below resources may be used to support this activity.

NCDA Flyer for GPs (England)

NCDA Flyer for CCGs and Cancer Alliances (England)

Other resources will be made available here in future.

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 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[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

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