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Evaluation, Research and Development Unit

RCGP National Audit of Cancer Diagnosis in Primary Care

The earlier a cancer can be diagnosed the greater the prospect of a cure. The later a cancer is diagnosed the harder it is to treat and the poorer the patient's chances of survival. Evidence suggests that later diagnosis of cancer has been a major factor in the poorer survival rates in the UK compared with some other countries in Europe. One of the priorities of the Cancer Reform Strategy is to diagnose cancers at an earlier stage. The National Awareness and Early Diagnosis Initiative aims to ensure that this work is taken forward. There are four workstreams, one of which includes a programme of development activity in partnership with the Royal College of General Practitioners, led by Professor Greg Rubin. It includes:

  • A baseline assessment of interval from first presentation to diagnosis
  • Significant event audit of cancer diagnosis
  • A template for the audit of cancer diagnosis in primary care

1. A baseline assessment of interval from first presentation to diagnosis Rationale: There is limited available data on the interval from symptom onset to diagnosis for most cancers. Through analysis of the General Practice Research Database we are measuring the interval from presentation to diagnosis for a range of cancers and for two time periods, 2001/2 and 2007/8. This work is being conducted with primary care academics at Bangor and Exeter and is near completion (November 2011).

2. Significant event audits for cancer diagnoses Significant Event Audit is a quality improvement tool that is in routine use in general practice. it provides a structured narrative analysis of the circumstances surrounding the event of interest.

We have adapted the NPSA / RCGP template for SEA, adding prompts that will aid the primary health care team in their completion of SEA for cancer diagnoses.

We have developed a method for the qualitative analysis a large number of SEAs for the cancer site, allowing recurring themes to be identified. These can then form the focus for service improvement. So far, we have done this in two Cancer networks and for four cancer sites, lung, ovary, upper gastrointestinal tract and cancers in teenagers and young adults.

3. A template for the audit of cancer diagnosis in primary care.  We have developed an audit template for use in general practice. In 2009/10 this was used by 1100 practices for 19000 patients with cancer, and a national analysis of the aggregated data has been completed. The audit template continues to be used by cancer networks in support of their primary care development initiatives.

National Audit of Cancer Diagnosis in Primary Care