Early Diagnosis of cancer: Guide to the GP Contract 2021/22 for Primary Care Networks (PCNs) and Practices

Coronavirus (COVID-19)

We have created a central resources hub for Health Professionals which hosts all of our CRUK resources and further materials to help with managing the pandemic. We are updating the information as guidance changes. There is also a page specifically for patients on our about cancer hub.

Health Professional COVID-19 and Cancer Hub

GPs play a pivotal role in diagnosing cancer earlier and supporting the NHS Long-Term Plan ambition to diagnose 75% of cancers at stage 1 or 2 by 2028.

The aim of this information is to support GP practices and Primary Care Networks to deliver on their GP contract requirements for the early diagnosis of cancer. See the GP contract requirements for 2021/22 or See the QOF QI changes for 2021/22.

"CRUK has a wealth of expertise and experience in both promoting early diagnosis and primary care engagement, so is ideally placed to help PCNs deliver their cancer agenda." - Dr Pete Holloway, CRUK GP.

These GP contract webpages and the recommendations have been developed with our team of CRUK GPs. The CRUK GPs are all practising GPs, as well as being involved in more strategic work across their respective Cancer Alliances.

How the early diagnosis of cancer features in the GP contract 2021/22

Primary care has a vital role to play in system-wide improvement efforts to increase the proportion of cancers diagnosed early, supporting the NHS Long Term Plan ambition to diagnose 75% of cancers at stages 1 and 2 by 2028. The ECD service requirements for PCNs seek to improve referral practice and screening uptake through network level activity and are aligned with the Supporting Early Cancer Diagnosis QOF QI Module which will run in 2021/22

Over the last year, PCNs have played a crucial role in maintaining and expanding general practice capacity, to address the continued needs of patients as practices respond to COVID-19, including the continuation of cancer services. PCNs will continue to play a critical role in recovering cancer services, and in particular in supporting the identification, rapid onward referral, and treatment of those 37,000 people who we would have expected to have started their cancer treatment in 2020/21.

To account for the impact of the COVID-19 pandemic on care, the Supporting Early Cancer Diagnosis Quality Improvement modules is to be repeated in their intended [2020-21] format (prior to amendments for the refocusing of QOF in September 2020) with some slight modifications to account for the impact of the pandemic on care.

In addressing QIECD005 and QIECD006, practices are expected to undertake quality improvement activity in both screening and early diagnosis:

  1. Participation in national breast, cervical and bowel cancer detection and prevention screening programmes among a practice’s registered population
  2. Referral practices for patients suspected of having cancer; including use of guidelines, professional development, safety netting of those referred on suspected cancer pathways and shortening of diagnostic intervals

The NHS has a stated ambition in the Long Term Plan that, by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients. Achieving this will mean that, from 2028, 55,000 more people each year will survive their cancer for at least five years after diagnosis. Primary care has a vital role to play in delivering this ambition, working closely with wider system partners including Cancer Alliances, secondary care, local Public Health Commissioning Teams and the voluntary sector.

In January 2019, NHS England and the BMA released a 5 year framework for GP contract reform to implement the NHS Long Term Plan.

The 2021/22 PCN specification and the QOF QI module both recognise the pivotal role that GPs play in diagnosing cancer earlier and support the NHS Long-Term Plan ambition to diagnose 75% of cancers at stage 1 or 2 by 2028, an increase from just over half now.

In 2020/21 the coronavirus pandemic presented major challenges for all healthcare systems. One of the most significant impacts was a sharp reduction in the number of people coming forward to general practice and being referred urgently with suspected cancer and reduced access and referral from cancer screening programmes.

The GP contract for 2021/22 therefore retains a focus on cancer early diagnosis as part of an overall Covid recovery plan.

Dr Debbie Harvey, CRUK GP recommends the following top tips:

  1. Make sure you check what is taking place (or being planned) locally before you embark on your own planning and actions, so you don’t reinvent the wheel
  2. There may be specific cancer working groups which bring together relevant stakeholders that you could tap into
  3. Support will be available from a range of organisations including your local CCG, who can help co-ordinate activities, to avoid working in silos
  4. Make sure you link in with your local Cancer Alliance and public health teams who will likely have local plans and resources to support you.
  5. Your area may already have a CRUK Facilitator, CRUK GP, Macmillan GP or other cancer lead who will be aware of specific work around cancer which might support you and avoid unnecessary effort and duplication
  6. CRUK is well placed to help practices/PCNs, and it should be noted that CRUK is an integral part of the support system for GPs and PCNs