Delivering the Primary Care Network (PCN) service specification on early cancer diagnosis 2021/22

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

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Enquire about free remote support in your area

Cancer Research UK Facilitator’s can help deliver your requirements

Contact your local CRUK Facilitator

The information below for Primary Care Networks focuses on the requirements for 2021/22. See the Network Contract DES specification 2021/22 - PCN Requirements and Entitlements

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.

CRUK Facilitators can help you to plan and deliver on the requirements for your PCN, and offer free, tailored support to improve your referral process, increase screening uptake and deliver through a community of practice. See below for further detail or get in touch.

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
  • Identifying and implementing specific actions to address unwarranted variation and inequality in cancer outcomes, including access to relevant services

Practices in the PCN will be required to use the relevant SNOMED codes to record:

  • Delivery of safety netting for patients on urgent referral pathway for suspected cancer – from October 2020

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.
 

If you took part in the 2019 National Cancer Diagnosis Audit, take a look at your NCDA report to help understand how patients were diagnose with cancer at your practice to plan targeted QI. If not, have a look at the audit on the RCGP webpages which is similar to the NCDA.

 

Review your tailored PCN report for the NCDA or any other PCN-wide audits 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

Understand the impact of Covid on referrals by reviewing CRUK’s regularly updated cancer statistics

Have a look at the e-RS referral data for your CCG (updated monthly) to understand if referral levels locally are returning to pre-Covid levels and/or which cancer types are still challenged.

 

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
 

Encourage your practices to access the CRUK Covid Hub for health professionals to see the resources to support referrals during Covid recovery. Specifically:

 

 

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 which includes a Summary Table, Flowchart, and Workbook and videos on how to use your clinical systems to embed safety netting. 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 the new Snomed codes for Safety Netting.
  Ensure all your practices are aware of and using the new SNOMED code for safety netting. Click here for more details

 

Ensure patients receive high-quality information:
 

Have a look CRUK’s patient information about urgent referrals and promote CRUK’s Urgent Referral Explained leaflet  amongst your practices to help prepare patients for their referral and minimise DNAs. Some PCNs have added a step to their admin process to text this link after a referral is made:

There may be other local resources to help – check locally.

 

CRUK GPs use software packages to support high quality information for patients and advice:

  • Consider backing up safety-netting advice via an AccuRx text such as “Please book another appointment if your cough hasn’t settled within 1 week of completing your course of antibiotics.”
  • Set up an AccuRx preset text for all 2WW referrals such as “You should receive an appointment at the hospital within 2 weeks (by x/x/xx), if you haven’t, please inform our reception team.”
  • Consider writing simple, specific management plans that you can copy and paste into an AccuRx text.
  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
Support with remote consultations and patient access during pandemic
 

Encourage your practices to access the number of resources on remote consultations, especially those which have cancer-specific considerations including:

  GatewayC have produced a webinar on effective telephone consultations: GatewayC Webinar – Effective Telephone Consultations
  CRUK has produced some top tips for patients about remote consultations
   Macmillan Top 10 Tips on remote consultations
 

In terms of patient access, Pulse has written an article and shared some key learning points from GPs on ways to ensure patients are well informed when they need to access primary care services. You can also log 1-hour CPD and download your certificate towards your revalidation from reading the full article.

Your local CRUK Facilitator can review your PCN level data both from the NCDA (if applicable) and on PHE Fingertips. They can create a bespoke data pack to help you to understand the findings and highlight areas of good referral practice, as well as identify variation and areas for improvement.

They can then support you to improve your referral processes by:

  • Providing access to the latest evidence, online resources, learning platforms and best practice
  • Helping to agree and standardise information given to patients at referral
  • Introducing a standardised safety netting approach to monitor patients referred for suspected cancer
  • Helping to facilitate communication between primary and secondary care to improve the quality of referrals for both GPs and consultants

Your Facilitator will help you to agree your aims and create an implementation plan for your PCN.

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.

Support the restoration of the NHS Cervical Screening Programme by identifying opportunities across a network to provide sufficient cervical screening sample-taking capacity.

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.

Public Health England have a dedicated section on their website about identifying and reducing inequalities in screening programmes. You can also watch the presentations on demand from the PHE Screening Inequalities Conference held in February 2021

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

Public Health England have developed some animations to help understand the basics of screening and the different screening tests that men and women will be invited for throughout their lives, view them here

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

Your local CRUK Facilitator can review your PCN level data both from the NCDA (if applicable) and on PHE Fingertips. They can create a bespoke data pack to help you to understand the findings and highlight areas of good practice in screening, as well as identify variation and areas for improvement.

They can then identify interventions to improve screening uptake tailored to the needs of your PCN population, including:

  • Supporting you to identify particular groups of patients where there are inequalities in uptake how to focus QI activity on these groups
  • Setting up a clinical and non-clinical practice cancer champion programme, and providing training on screening programmes
  • Agreeing and implementing a process for following up screening non-responders across the PCN
  • Helping to find further solutions to issues within practices by facilitating local action planning – helping them to meet and maintain screening targets

Your Facilitator will help you to agree your aims and create an implementation plan for your PCN.

Support delivery through a community of practice

Establish a community of practice between practice-level clinical staff to support delivery of the requirements of the Network Contract DES Specification and:

  1. Conduct peer to peer learning events that look at data and trends in diagnosis across the PCN, including cases where patients presented repeatedly before referral and late diagnoses
  2. Engage with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance and Public Health Commissioning teams
  3. Identify successful QOF QI activity undertaken by member practices, and ensure that successful practice is implemented and developed across the PCN

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

 

* The level of support your local CRUK Facilitator can offer will differ depending on your area, please get in touch for more details.

Your local CRUK Facilitator, CRUK GP, Macmillan GP or other cancer lead will be aware of specific work around cancer which can support you, helping you to avoid unnecessary effort and duplication. The level of support offered will differ depending on area.

Your local CRUK Facilitator can support you to use PCN level NCDA data reports (where applicable) to influence change regionally and locally.

They can also support you to convene community of practice/PCN-wide meetings during the year with all member practices and will play a role to:

  • Encourage your practices to review their cancer diagnoses and bring them together to share any learning
  • Signpost to education and resources
  • Encourage practice engagement with local system partners, particularly Cancer Alliances, to deliver the service requirements
  • Organise speed-networking events to enable PCNs to meet other system partners
  • Help you to agree your aims and create an implementation plan for your PCN

 

Monitoring performance and benchmarking

A PCN dashboard was launched in 2021 and includes key metrics to allow every PCN to see the benefits it is achieving for its local community and patients. It is intended to support local quality improvement, enabling benchmarking between practices within PCNs, and between comparable PCNs.

In line with the PCN requirements, practices of a PCN must use the relevant SNOMED code for Safety Netting. Only those codes included in the supporting Business Rules will be acceptable to allow CQRS calculations. A PCN’s Core Network Practices will therefore need to ensure that they use the relevant codes and if necessary, re-code patients. 

Ensure you use the new SNOMED code for: Delivery of safety netting for patients on urgent referral pathway for suspected cancer. You can search for this by putting in ‘cancer safety netting’ into your code browser and will find the code 1239431000000107.

However, to make the best use of this, we would advise using safety netting templates which incorporate this SNOMED code and allow you to tick the relevant section on the templates, as well as set a date for any reminders.

Have a look at your PCN’s use of the official Snomed codes for Safety Netting compared to other PCNs, using the PCN dashboard.

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