Assessing the impact of an english national initiative for early cancer diagnosis in primary care

G. Rubin*, Carolynn Gildea, S. Wild, J. Shelton, I. Ablett-Spence

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Background: The Cancer Networks Supporting Primary Care programme was a National Health Service (NHS) initiative in England between 2011 and 2013 that aimed to better understand and improve referral practices for suspected cancer. Methods: A mixed methods evaluation using semi-structured interviews with purposefully sampled key stakeholders and an analysis of Cancer Waiting Times and Hospital Episode Statistics data for all 8179 practices in England were undertaken. We compared periods before (2009/10) and at the end (2012/13) of the initiative for practices taking up any one of four specified quality improvement initiatives expected to change referral practice in the short to medium term and those that did not. Results: Overall, 38% of general practices were involved in at least one of four quality improvement activities (clinical audit, significant event analysis, use of risk assessment tools and development of practice plans). Against an overall 29% increase in urgent cancer referrals between 2009/10 and 2012/13, these practices had a significantly higher increase in referral rate, with reduced between-practice variation. There were no significant differences between the two groups in conversion, detection or emergency presentation rates. Key features of successful implementation at practice and network level reported by participants included leadership, organisational culture and physician involvement. Concurrent health service reforms created organisational uncertainty and limited the programme’s effectiveness. Conclusions: Specific primary care initiatives promoted by cancer networks had an additional and positive impact on urgent referrals for suspected cancer. Successful engagement with the programmes depended on effective and well-supported leadership by cancer networks and their general practitioner (GP) leads.

Original languageEnglish
Pages (from-to)S57-S64
JournalBritish Journal of Cancer
Volume112
DOIs
Publication statusPublished - 2015

Bibliographical note

Funding Information:
CWT data were obtained from the National CWT Monitoring Data Set, provided by NHS England. Hospital Episode Statistics data were used with permission from the Health and Social Care Information Centre. This analysis was funded by NCAT, as part of the evaluation by Durham University of the Cancer Networks Supporting Primary Care programme. We thank Rebecca Brown for her contribution to analyses while part of the East Midlands Knowledge and Intelligence Team. Finally, we thank all those who gave up valuable time to participate in the qualitative interviews.

Keywords

  • General practice
  • Leadership
  • Quality improvement
  • Referral

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