Referral quality

Review Referral Practice

This will enable and support practices to consider

Referral

• Review practice level data to explore presentation and diagnostic trends – eg. PHE Fingertips data
• Review the quality of suspected cancer referrals (in line with NICE NG12) – through audit and reflective practice
• Make use of and available Clinical Decision-Making Tools
• Make use of Rapid Diagnostic Pathways for Vague Symptoms

Examples of Potential Projects and Workstreams

Using Audits to Identify Improvements and Influence Change

Audit enables practices to see what is working well and any areas that need improvement. Consider auditing and then sharing anonymised learning at peer review.

Auditing Cancers Diagnosed

This is a great way to review how cancer is diagnosed in practice. Are the practice referrals meeting the NICE 12 guideline?

The Process

The Primary Care Network should agree which cancers should be included based on local needs and local data. Do not forget to include patients who have died or moved practice in the audit.

• Audit and then share anonymised learning at a peer review session. The audit should look for delays in the cancer diagnosis, this includes patient delays, primary care delays or secondary care delays.
• Delays can be related to diagnostics (not having urgent results within 14 days) or system delays failure to arrange a test or a referral.
• Practice should agree a plan to reduce any identified delays or issues

Examples of audits include –

• Patients diagnosed by emergency admission (these patients have a poor prognosis).
• A specific tumour pathway for example Lower GI (high incidence, difficult pathway) Lung, Urology, Breast or Upper GI (other high incidence cancers).
• 20 consecutive new cancers (including patients diagnosed during the COVID-19 pandemic – could also support safety netting)
• Patients referred with serious but non-specific symptoms of cancer.
• Other Primary Care Network agreed groups.

Quick Hints Tips and Tools

Use the Gateway C – Improve the Quality of Referral Module (E-learning) to help get started. Link to Gateway C Module

Save the following documents to your desktop for easy access:

Retrospective Cancer Audit

Referral Completeness Audit

Undertaking Significant Event Audits

It is suggested good practice that if the cancer cases audit does identify any complex cases with delays, particular challenges or issues that a Significant Event Audit is completed and learning shared and recorded.

The RCGP standard template is available see and instruction:

• Leading effective and sustainable Quality Improvement within a Primary Care Network: A How To Guide (PDF file, 479 KB)

Early diagnosis of cancer

• How can your practice undertake quality improvement activity focused on early diagnosis of cancer? (PDF file 78.1 KB)
  • QOF QI Early diagnosis of cancer case study: Bowel cancer screening (PDF file, 259 KB)
  • QOF QI Early diagnosis of cancer case study: Cervical screening (PDF file, 233 KB)
  • QOF QI Case study: Early diagnosis of cancer based on NCDA outcomes (PDF file, 328 KB)

Supporting people with learning disability

• How can your practice undertake quality improvement activity to support people with learning disabilities? (PDF file, 65.8 KB)
• QOF QI Case study: Improving the knowledge and understanding of practice team members about the needs of the practice’s learning-disabled population (PDF file, 257 KB)
• QOF QI Case study: Learning disability death review (PDF file, 197 KB)

Undertaking Significant Event Audits – Hints Tips and Tools

Example of Fast Track Suspected Cancer Referrals Completeness Audit – here