Cancer Waiting Times: Time to be Proactive

Friday 28th June 2019

by Kate Smith, Business Analyst, NECS Consultancy

More than one in three people will be diagnosed with cancer within their lifetime1.

In 2014 the NHS Five Year Forward View identified the prevention, early diagnosis and treatment of cancer as some of its top priorities1,2. 5 years on and cancer survival rates are at an all-time high3 and the number of GP urgent referrals has increased by 45% from 1,545,360 to 2,239,4534. Whilst this is very positive, an unwelcome side effect is the realisation that our healthcare system is struggling to cope with the ever-increasing volume of cancer referrals. As a result, patients are not necessarily receiving the care they need within clinically appropriate timescales.

So, what options do we have? For many the answer is obvious: focus on improving speed and efficiency and increasing capacity. This is something the healthcare system is doing well; the NHS Long Term Plan commits to introducing Rapid Diagnostic Centres and straight-to-test options to reduce cancer pathway lengths3, and NECS recently supported a successful project that oversaw the spend of an additional £10m which increased national capacity. However, it must be recognised that these strategies deliver short-term solutions, and the need to invest in the development and implementation of more holistic solutions has never been greater.

Interestingly an audit NECS recently conducted revealed that managers of cancer services within acute hospitals  feel that there should be a better system in place to manage low-risk referrals. Their opinion is not without justification: 90% of people who are urgently referred on a 2 week wait pathway by their GP are not diagnosed with cancer5. With this in mind, if low-risk patients were managed differently at the start of their cancer pathway, the pressure on hospitals would somewhat be relieved and those patients that are diagnosed with cancer will be seen and treated more quickly.

Given that the vast majority of cancer referrals come from GPs4, it would be beneficial to review the referral process from primary care settings. At present both NICE guidelines6 and decision support tools7 are available to GPs to help inform decision-making. However, has it now come to a point where more detailed risk stratification models should be utilised to categorise suspected cancer cases and hence better control cancer referrals? We have never been more capable of doing something like this; advancements in cancer research and technology lends itself well to the development of such tools.

It goes without saying that it remains important to focus on overall 62-day performance. Yet through more proactive approaches we need to start to improve the quality of initial cancer referrals and ensure patient demand is directed to the right part of the system.

Contact NECS Consultancy to understand how we have supported clients to think differently and develop new models of care.  Find out more here: NECS Consultancy

References

  1. NHS England. 2017. Next Steps on the Five Year Forward View: Cancer. [Accessed 14 June 2019]. Available from URL: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/cancer/
  2. NHS England. 2014. Five Year Forward View. [Accessed 14 June 2019]. Available from URL: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
  3. NHS: The Long Term Plan. 2019. Chapter 3: Further Progress on Care Quality and Outcomes. [Accessed 14 June 2019]. Available from URL: https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/better-care-for-major-health-conditions/cancer/
  4. NHS England Cancer Waiting Times. 2019. Cancer Waiting Times – National Time Series Oct 2009 – Apr 2019 (Provider-based) with Revisions (XLSX, 160KB). [Accessed 14 June 2019]. Available from URL: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/
  5. Cancer Research UK. 2018. Your Urgent Referral Explained. [Accessed 14 June 2019]. Available from URL: https://www.cancerresearchuk.org/cancer-symptoms/what-is-an-urgent-referral
  6. National Institute for Health and Care Excellence. 2017. Suspected cancer: recognition and referral. [Accessed 14 June 2019]. Available from URL: https://www.nice.org.uk/guidance/ng12
  7. Macmillan Cancer Support. 2019. Cancer Decision Support (CDS) tool. [Accessed 14 June 2019]. Available from URL: https://www.macmillan.org.uk/about-us/health-professionals/programmes-and-services/prevention-early-diagnosis-programme/cancer-decision-support-tool.html