Improving Referral Practice

A PCN should work with Cancer Alliances and local systems to increase early diagnosis rates and improve referral practice. Together, PCNs and Alliances should develop a clear set of actions and milestones to improve referral practice for:

  • Colorectal and lung cancer, which together account for nearly 40% of all late-stage cancer diagnoses.
  • One other cancer type determined locally, based on burden of late-stage diagnoses and opportunities for timely and effective referral to support earlier diagnosis.

A PCN should also work with Alliances and its GP Practices to:

  • Review the recommendations of, and ensure local referral practice reflects, NICE Guideline NG12
  • Audit referrals for people who have received a diagnosis of cancer.
  • Assess different stages in the pathway for improvement, for example, the interval between first presentation and when an urgent suspected cancer referral is made and the number of appointments prior to urgent suspected cancer referral.
  • Promote use of Faecal Immunochemical Testing (FIT) to patients with signs and symptoms of colorectal cancer to identify those requiring a Lower GI Urgent Suspected Cancer referral.
  • FIT testing should be delivered in accordance with NICE Diagnostics Guidance 56.
  • Patients living in more deprived areas are more likely to be diagnosed with bowel cancer at a later stage and are less likely to complete a FIT test.
  • PCNs should target action to address variation in completion of FIT tests in symptomatic patients by deprivation and develop patient education and safety netting approaches to follow up with those who have not returned their FIT test.
  • Promote use of Non-Specific Symptom (NSS) pathways for patients with symptoms that could indicate cancer but who do not fit clearly into a single Urgent Suspected Cancer referral pathway.
  • PCNs should support practices to undertake filter function tests for NSS patients, as outlined in Annex 1 of the Faster Diagnosis Framework.