Improving referral quality – bowel, lung and bladder cancer

PCNs and constituent practices are encouraged to review the quality of their cancer referrals and referral processes to improve early diagnosis and patient outcomes. Both in general and in respect to lung, bowel and bladder cancer.

Referral quality activity:

• Review practice level data to explore presentation and diagnostic trends e.g. OHID PHE Cancer Fingertips Data, Primary Care Networks Dashboard and other data sources. PCN Facilitators can provide your PCN with a data pack.
• Complete a clinical audit to review the quality of urgent suspected cancer referrals (in line with NICE NG12).
• Use available clinical decision-making support tools.
• Review safety netting practices.
• Ensure the appropriate use of diagnostic tests and pathways e.g. FIT, teledermatology, NSSPs.

Primary Care Networks should undertake QI activity against the prioritised tumour sites in line with the national DES requirements and regional data driven priorities.

DES tumour specific QI activity

We have selected bladder cancer as a focus for 2025/26 due to:

• Lower survival rates than the England average.
• Significant proportion of bladder cancers diagnosed via emergency and routine referral.
• Poorer one and five-year survival rates for women compared to men.

Bladder cancer toolkit

In support of this we have produced a 👉 bladder cancer toolkit for clinical staff which provides resources covering:

• Data trends – national and regional picture
• Supporting reflective practice, quality Improvement/audit
• Symptom/risk management/safety netting
• Higher risk groups and public symptom awareness
• Educational resources

Bladder cancer audit

We are encouraging PCNs/practices to conduct a retrospective ‘routes to diagnosis’ audit of bladder cancer cases, including a review of bladder symptom management i.e. repeat UTIs and non-visible haematuria. This should identify strengths in practice, diagnostic challenges and areas for improvement at practice/PCN and regional level. The following tools are in place to support the process:

👉 Audit guide

👉 Audit template

👉 Pre-prepared clinical searches request form

👉 EMIS bladder import guide

👉 SystmOne bladder cancer searches

👉 Bladder staging guidance

👉 PCN facilitators

 

When relevant it is good practice to share anonymised learning with peers and identify any cases for learning event analysis. Macmillan have produced 👉 LEA good practice guidelines.

To support wider regional improvements PCNs are requested to submit a summary of their audit outcomes to the Northern Cancer Alliance. Facilitators can assist PCN leads to develop and submit the report.

Bladder cancer education

👉 NCA bladder cancer recognition and USC referral webinar

👉 NB Medical/Action Bladder Cancer UK hot topics bladder cancer webinar

👉 CRUK Urological Cancers (note: you will need an account to access the recording)

Lung and colorectal cancer

NHS England have included these tumour sites in the DES because of their significant contribution to late-stage diagnosis (40% of late-stage diagnosis).

Colorectal/FIT

We recommend practices use the NHS England FIT dashboard and local lab data to monitor and improve IIF thresholds. PCN Facilitators can provide access to this data.

Key colorectal FIT quality improvement activities:

• Appropriate coding of both FIT results and USC referrals (especially when a combined upper/lower GI referral used).
• Protocols to support FIT safety netting and fail safes for vulnerable and disadvantaged patients.
• Ensure clear instructions, information and support is given to patients to complete the test in appropriate formats.
• Ongoing training for both clinical and non-clinical practice staff

Further information on FIT, including patient information, can be found 👉 here.

 Colorectal/FIT education and guidelines

👉 NCA cancer hot topics (early diagnosis) webinar

👉 FIT Test FAQs for GPs

👉 NICE endorsed BSG FIT guidelines explained

👉 GatewayC

FIT Patient Information Resources

Below are links to a patient leaflet for use in primary care.

👉 FIT symptomatic patient information leaflet colour

👉 FIT symptomatic patient information leaflet black and white

👉 Information animation to support patients completing a symptomatic FIT test

Lung Cancer

Lung cancer is an ICB clinical priority. PCN activities can contribute to improving lung cancer detection and patient outcomes.

Potential Activities

Lung Cancer Risk and Detection

• Establish low threshold for CXR in symptomatic patients in line with NICE NG12.
• Consider NG12 criteria, patient risk and threshold for CXR at these opportunities:
  • People with recurrent/persistent chest infection
  • COPD reviews and symptomatic presentation for change in COPD symptoms – more breathless or change in cough

MECC (Making Every Contact Count)

PCN pharmacy staff, care coordinators and other appropriate staff should target smokers/ex-smokers to offer smoking very brief advice (VBA) and lung cancer symptom awareness.

Supporting the lung screening programme

Lung cancer screening is being rolled out across the region, targeting current and ex-smokers aged 55–75yrs.

Supporting the lung screening programme is a valid DES activity, PCNs should:

• Ensure current and ex-smokers are coded appropriately i.e. a patient who has given up smoking should be recorded as ex- smoker not non-smoker.
• Proactively search for and engage with eligible patients with no smoking status recorded (also supports QOF). Target those patients who meet the lung screening age eligibility criteria.
• Encourage smokers and ex-smokers to engage when invited. Trusted health professionals advocating the test really makes a difference.
• Work with lung screening programme managers to establish if GP invitation priming texts and communications with patients would be useful.
• Promote the screening programme.

Lung and smoking very brief advice (VBA) training

👉 GatewayC – lung cancer

👉 Smoking very brief advice

Other activities and resources to improve referral quality

👉 Retrospective cancer audit – all tumour sites

Specific health inequalities projects – learning disabilities

👉 Guys Cancer Academy cancer care for people with learning disabilities

👉 RCGP how can your practice undertake quality improvement activity to support people with learning disabilities?

👉 QOF QI case study: improving the knowledge and understanding of practice team members about the needs of the practice’s learning-disabled population

Education and support materials

👉 Cancer Research UK NICE guidelines – interactive symptoms guide

👉 GatewayC improving the quality of your referral

👉 NCA accessible, easy-to-understand information for patients and carers

Incidental findings will be one of the outcomes from lung health check CT scans. The most common is coronary artery calcification.

Please read the information here from Dr Alan Bagnall, Consultant Cardiologist, and watch the video to understand more about this condition and what it means for your patients.