An overview of the proposed Network service specification for the 2020/21 GP contract
This service aligns with the NHS Long Term Plan ambition to increase the proportion of cancers diagnosed at an early stage, from around half to three-quarters of diagnoses by 2028.
The main service objectives are to:
- Improve referrals processes across GP practices,
with new standardised systems and processes for identifying and referring for suspected
cancer
- Increase uptake of national cancer screening
programmes
- Improve outcomes locally by achieving 60 more
early cancer diagnoses a year in an average PCN
Service requirements
The full service specification is to be phased in over four years.
For 2020/21, PCNs would be expected to:
1. Identify a clinical lead responsible for the delivery of the service requirements.
2. Improve referral practice for suspected cancers, including recurrent cancers. This will be done by:
- Using local data including practice level data to explore local patterns in presentation and diagnosis of cancer.
- Enabling and supporting practices to improve the quality of their referrals for suspected cancer, in line with NICE guidance and making use of Clinical Decision Support Tools and the new Rapid Diagnostic Centre pathway for people with serious but non-specific symptoms where available.
- Introducing a consistent approach to monitoring patients who have been referred urgently with suspected cancer or for further investigations undertaken to exclude the possibility of cancer (‘safety netting’) in line with NICE Guideline 12.
- Ensuring patients receive high-quality information on their referral
3. Increase uptake of National Cancer Screening Programmes. This will be done by:
- Leading and coordinating constituent practices’ contribution to a local screening uptake improvement plan, working with the local Public Health Commissioning team and Cancer Alliance. PCNs should identify actions relevant for their particular populations that they will take forward.
- Building on actions to agree and deliver with practices any 2020/21 improvement activity identified.
- Standardising processes
- Working with local system partners to agree a 2021/22 Network-level action plan for improving uptake of cancer screening programmes across the PCN.
4. Improve outcomes through reflective learning and local system partnerships. This will be done by:
- Developing a community of practice among practice level clinical staff that will inform Network-level improvement action plans
- Investigating historical referral diagnosis data to identify trends and opportunities for proactive work across the PCN to improve referrals and early diagnosis, and to identify cases which should be used for peer to peer learning and significant event analysis.
- Facilitating and supporting constituent practices to conduct Network-wide Significant Event Analyses and peer to peer learning sessions, taking advantage of the broad range of cases across a PCN.
- Facilitating and encouraging practices’ engagement with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance and Public Health Commissioning teams, to inform ongoing improvement activity.
Proposed metrics for assessing PCN delivery of this service
1. The proportion of cancers diagnosed at early stage (stage 1 and
2) – progress towards local Cancer Alliance target
2. PCN-level participation in breast, bowel and
cervical screening programmes
3. Proportion of urgent cancer referrals that were
safety netted
The number of new cancer cases treated that have
resulted from a two week wait referral (the ‘detection’ rate)
4. The number of two-week referrals resulting in a
diagnosis of cancer (the ‘conversion’ rate)
5. Number of cancers diagnosed via emergency presentation
Full details of the specification can be downloaded here.