National Cancer Diagnosis Audit

What is the National Cancer Data Audit?

The National Cancer Data Audit (NCDA) was a UK-wide programme which ran in 2014 and 2018 with the aim of helping us to better understand pathways to cancer diagnosis in primary care and where improvements could be made to achieve better cancer outcomes.

We supported the NCDA to drive improvements in early cancer diagnosis at GP Practice, local, regional and national levels to provide a valuable and unique data set on patient pathways to diagnosis from the point of presentation to primary care. The NCDA partnership involved support and input from, The Royal College of General Practitioners, Macmillan Cancer Support, Public Health England (specifically the National Cancer Registration and Analysis Service), NHS England, Public Health Scotland, Scottish government, Public Health Wales (specifically the Welsh Cancer Intelligence and Surveillance Unit), the Wales Cancer Network, the Northern Ireland Cancer Registry (at Queen’s University Belfast), as well as our patient representatives and academic partners.

The NCDA encouraged an in-depth review of the referral pathway to cancer diagnosis inviting Primary Care Networks and Practices to take part and perform a retrospective review of their patients’ pathways. The audit collected data from participating GPs on the patients who had presented to the practice with symptoms who were subsequently diagnosed with cancer. GPs were asked to record the following data for each patient:

• Presenting signs and symptoms

• Referral types used for patients later diagnosed with cancer

• Use of tests and investigations prior to referral

• Use of safety netting

• Interval length from patient presentation to referral and diagnosis

• Avoidable delay as judged with hindsight by the GP

Tailored data feedback was then provided to GP practices to support learning and quality improvement.

For more information, read the FAQ document(PDF, 226 KB)

Quality Improvement and Key NCDA Insights

Data from the NCDA helped us to better understand how cancers are diagnosed and helped practices identify areas for improvement. It led to changes in 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 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

Download the 2021 NCDA Impact report(PDF, 6.85 MB)

Download the QI Toolkit(PDF, 940 KB) (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.)

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

Findings from the audit, which compared new cancer diagnoses in 2014 and in 2018, showed:

• The proportion of patients urgently referred with suspected cancer rose from 52% to 55% from 2014-2018.

• Similar proportions of patients were diagnosed in stages I-II (55% in both 2018 and 2014), and stage IV (25% and 27% in 2018 and 2014, respectively).

• There was a reduction in Primary Care Internal (PCI) lengths, the number of patients experiencing 3+ consultations prior to referral, and emergency referrals.

• There were some areas for concern. For example, the documentation of safety netting had decreased 4% from 2014-2018.

• Diagnostic interval (DI) demonstrated only a relatively modest decrease (possibly due to progress in primary care diagnostics, and secondary care capacity was not matched to cope).

• GPs reported 23% of all diagnoses were considered to have some element of avoidable delay​.

• The use of diagnostic tests in primary care was largely unchanged from 2014 despite NG12 recommendations. For example, only 10% of patients with oesophageal cancer had endoscopy prior to referral, FIT testing for symptomatic patients was used in fewer than 1% of patients with colorectal cancer). Please note, data is from 2018, so this may have changed and requires further investigation​.

How to carry out a local audit

Practices can use the NCDA data proforma or NCDA Excel template to carry out internal audits of cancer diagnosis at their practice. For internal practice audits, a GP system search to identify cases will be necessary. National cycles of NCDA have so far audited all cancer types, practices may wish to focus on common cancers with unmet needs, such as lung or bowel, late stage diagnoses, or on certain pathways, such as emergency diagnosis routes.

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

The number of eligible cases varies by practice size and patient population. On average, a practice can expect 3-4 patients per month eligible for NCDA, which will mean a time commitment of under 2 hours per month for the audit. The workload can be split between multiple GPs at the practice, and data entry can also be supported by GP Trainees/Registrars under supervision of an experienced GP.

NCDA data template(XLSX, 542 KB)

NCDA data proforma(DOCX, 39.2 KB)

Publications

National findings have been presented in academic papers (see publications 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.

Supporting documents and tools

• NCDA data template(XLSX, 542 KB)

• NCDA data proforma(DOCX, 39.2 KB)

• FAQ document(PDF, 226 KB)

• NCDA impact report(PDF, 6.85 MB)

If you would like to contact us regarding the NCDA or have any updates on how you have used this tool please email us at healthsystemsengagement@cancer.org.uk.

This National Cancer Diagnosis Audit is operationally managed by Cancer Research UK, but is a broad partnership that involves support and input from: The Royal College of General Practitioners, Macmillan Cancer Support, Public Health England (specifically the National Cancer Registration and Analysis Service), NHS England, Public Health Scotland, Scottish government, Public Health Wales (specifically the Welsh Cancer Intelligence and Surveillance Unit), the Wales Cancer Network, the Northern Ireland Cancer Registry (at Queen’s University Belfast), as well as our patient representatives and academic partners.