Delivering the PCN service specification on early cancer diagnosis 2020/21

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The information below focuses on the requirements for 2020/21. See the GP contract requirements for 2020-21

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.

Review referral practice:

Review referral practice for suspected cancers, including recurrent cancers. This will be done by:

  • Enabling and supporting practices to review the quality of their referrals for suspected cancer, in line with NICE Guideline 12. This should make use of:

    • Clinical Decision Support Tools
    • Practice-level data to explore local patterns in presentation, and diagnosis of cancer
    • The new Rapid Diagnostic Centre pathway for people with serious but non-specific symptoms - where available
  • Building on current practice to ensure a consistent approach to ‘safety-netting’ patients who have been referred urgently with suspected cancer or for further investigations to exclude the possibility of cancer
  • Ensuring that all patients are signposted to or receive information on their referral including why they are being referred, the importance of attending appointments and where they can access further support

CRUK GP Dr Pawan Randev makes the following recommendations on how PCNs can support practices to improve their referral processes:

Understanding your data:
  Review the newly available PCN level reports on PHE Fingertips This will help you to benchmark your practices to understand any variation and to identify where improvements can be made for your PCN
 

Encourage your practices to sign up for the National Cancer Diagnosis Audit before 17th of April and to complete their audits by 30th April to get tailored feedback in May 2020. If all practices within a PCN contribute to the NCDA, you will also receive a data report for your PCN.

  Review your tailored PCN report for the NCDA to highlight existing good practice within the PCN, and help to identify any shared concerns or areas for PCN-wide targeted quality improvement. Using the data, encourage mutual learning and sharing of best practice, e.g. where one practice’s report shows they are doing well in an area that others within the PCN may be struggling with. You will be helping your member practices to get their QOF points too

 

 

Improving the quality of referrals:
  Encourage your practices to take the free Gateway C module ‘Improving the Quality of Your Referral’ which focuses on clinical decision making and safety netting, what patients want to know when a referral is made, and what information that should be included in the referral to reduce avoidable delays at secondary care. Read about the module. Go to the module
  Encourage your practice to undertake CPD activities relating to the early diagnosis of cancer. CRUK has a range of face to face, on-line and e-learning opportunities
  Access NG12 summaries and visualisation tools such as the Cancer Maps, CRUK ‘body’ infographic and interactive desk easel and Macmillan Top Tips

 

 

Introducing safety netting approaches:
  Enquire about free tailored support for your PCN from your local CRUK Facilitator. Facilitators can provide free workshop for your PCNs and tailored assistance in safety netting involving PCN clinical and administrative teams
  Encourage your practices to access the CRUK Safety Netting hub where you can find a workbook and self assessment checklist, as well as information about best practice and a useful infographic. Facilitate discussion between your practices about their current safety netting processes and agree what best practice looks like and how you will collectively implement a consistent approach, including using Snomed codes when available later in 2020
  Download the Cancer Insight on Safety Netting and make sure your practices see a copy

 

 

Ensure patients receive high-quality information:
  Promote CRUK’s Urgent Referral Explained leaflet amongst your practices to help prepare patients for their referral and minimise DNAs
  Encourage your practices to use the CRUK’s Safety netting checklist for patient communication
  Encourage your practices to take the free Gateway C module ‘Improving the Quality of Your Referral’ which focuses on what patients want to know when a referral is made. Read about the module. Go to the module

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

Contribute to improving local uptake of National Cancer Screening Programmes

Contribute to improving local uptake of National Cancer Screening Programmes by working with local system partners – including the Public Health Commissioning team and Cancer Alliance – to agree the PCN contribution to local efforts to improve uptake.

This should build on any existing actions across practices and include at least one specific action to engage with a group with low-participation locally.

CRUK GP Dr Neil Smith makes the following recommendations on how PCNs can support practices to improve their screening uptake:

Review the newly available PCN level reports for screening uptake on PHE Fingertips.  This will help you to benchmark your practices to understand any variation and to identify where improvements can be made for your PCN
Practices may wish to look at particular groups of patients where there are inequalities in uptake and to focus their QI activity here. Download CRUK’s Reducing inequalities in bowel cancer screening guide
Make sure your practices know about CRUK’s Bowel Screening Good Practice Guide and the other valuable resources on the CRUK Bowel screening hub such as the CRUK video on how to do the test with non-responders and information about the new FIT screening test. Download CRUK's Cancer Insight on bowel screening and make sure your practices see a copy
Make sure your practices know about CRUK’s Cervical Screening Good Practice Guide (UK-wide) and look at the resources and evidence base on increasing cervical screening uptake. Download CRUK's Cancer Insight on cervical screening and make sure your practices see a copy

Enquire about free tailored support for your PCN from your local CRUK Facilitator. They can help you to identify interventions to improve screening uptake tailored to the needs of your PCN population. Interventions which have been found to consistently support improvements in bowel screening uptake have been reported as: pre-screening reminders, GP endorsement, more personalised reminders for non-participants and more acceptable screening tests

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

Support delivery through a community of practice

Support delivery of the specification* through a community of practice between practice-level clinical staff that will:

  • support constituent practices to conduct peer to peer learning events that look at data and trends in diagnosis across a Network, including cases where patients presented repeatedly before referral and late diagnoses
  • support engagement with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance and Public Health Commissioning teams.

 

*The Supporting Early Cancer Diagnosis specification says PCNs will:

  1. Improve referral processes for suspected cancers, with a focus on safety netting, ensuring that all patients receive information on their referral
  2. Contribute to improving local uptake of National Cancer Screening Programmes working with local system partners

CRUK GP Dr Chris Tasker makes the following recommendations on how PCNs can support practices to improve cancer outcomes through reflective learning and local system partnerships:

The PCN level NCDA reports (available where all practices have participated) may be used to influence and affect change locally/regionally, as they can provide evidence of an issue affecting more than one practice, providing more leverage than individual practice reports, eg regarding training needs, limited access to tests or problems with referral pathways.

Encourage your practices to review your cancer diagnoses on a quarterly basis, and bring them together to share any learning specifically from any stage 3 or 4 cancers or patients diagnosed with lung or bowel cancer. Try using the RCGP Early Diagnosis of Cancer Significant Event Analysis Toolkit to support you with this

Convene community of practice/PCN-wide meetings during the year with all member practices. The purpose would be to raise awareness, understand who does what, signpost to education and resources and discuss possible actions, including:

  • what cancer data is available and how to interpret it
  • an overview of the NG12 guidance, referral forms and local pathways/criteria
  • what a good learning event analysis comprises
  • what robust safety netting involves and where/when to use safety netting and why this is so important
  • coding practice, use of templates and Clinical Decision Support tools
  • signposting to tools/resources and available support across the local health system
  • discussion about potential for pooling of resources and/or undertaking actions collaboratively to avoid duplication
  • at a later date:
    • review of who has done what since last meeting and main findings
    • share best practice and learning points and write-up successes/impact/learning
    • identify further actions required

Enquire about free tailored support from your local CRUK Facilitator for:

  • setting up a clinical and non-clinical practice cancer champion programme
  • facilitating community of practice meetings
  • facilitating PCN-wide learning event analyses and action planning
  • organising speed-networking events for your PCN to meet other system players e.g. community and secondary care colleagues, Cancer Alliances, public health/screening teams

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