Referral quality

Review Referral Practice

This will enable and support practices to consider

  • 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  –

Undertaking Significant Event Audits – Hints Tips and Tools

See the RCGP Toolkit link for SEAs Toolkit : RCGP SEA Video

National Cancer Diagnosis Audit (2019/2020) – Extended Due to COVID19
  • Already Registered – Complete case reviews Auditing Diagnosed Cancer Case.
  • Convene Reflective Peer Review Workshop at either practice or Primary Care Network level.

This national audit tool – automatically identifies confirmed patient cases for audit between Jan – Dec 2018. Covering presentation, patients’ routes to diagnosis, stage at diagnosis, analysis of any delays in care, flag for SEA.

  • Deadline for Case Submissions 31st August 2020.
  • Audit reports available October 2020
  • Summary Presentations can be provided by your Cancer Research UK Facilitator. Contact details can be found here

Auditing 2 week wait Referrals Form Completeness

Completeness of referral: incomplete referral forms cause delay and difficulty when secondary care plan further investigations and management. 

Does the form:

  • Meet the 2ww referral criteria
  • Give a reason for referral – having the full picture is essential to enable secondary care investigation and management.
  • Include patients performance status – to help plan which is the most appropriate set of investigation.
  • Identify the *COVID-19 Risk Status to assist with triage during pandemic
  • Provide timely bloods when appropriate – not having UEs may delay CT etc.

Hints Tips and Tools 

Example of 2ww Referral Completeness Audit – here