Download Updated 19.5.16 National Cancer Diagnosis Audit Frequently Asked

Updated 19.5.16
National Cancer Diagnosis Audit
Frequently Asked Questions
A. Why do we need a national cancer diagnosis audit?
1. What are the origins?
‘Achieving World Class Cancer Outcomes‘: a strategy for England 2015-2020 identified the
critical role of national clinical audit in driving improvement. Undertaking this audit in 29016
provides an opportunity for GP practices to understand their baseline of clinical practice
(prior to the introduction of the 2015 NICE guidelines for urgent referrals for suspected
cancer), and then to develop improvement plans, in order to secure earlier diagnosis of
patients, and ultimately save lives.
2. Who is involved in this audit nationally?
This National Cancer Diagnosis Audit is being operationally managed by Cancer Research
UK, but is a broad partnership that involves support and input from: the Royal College of
General Practitioners, Macmillan Cancer Support, NHS England, Public Health England
(specifically the National Cancer Registration and Analysis Service), UK cancer registries
and the Evaluation, Research and Development Unit at Durham University.
3. How is this audit different from the last national cancer diagnosis audit in 2010?
A. There are a number of differences. We are aiming to collect data from all UK nations and
the data will be analysed against standards. In terms of process, we are giving GPs
information from the cancer registry on which patients were diagnosed with cancer during
2014; and content-wise, we have reviewed the data items to ensure they will give the
greatest insight and have greatest impact. We have also refined consistent data items so
they have defined attributes. Importantly, there will be local feedback, so practices can
undertake further clinical improvement activities to improve their care for patients and help
improve cancer outcomes.
4. What are the benefits to me as a GP?
Although there is no national funding for this audit, there are a number of benefits for GPs
who take part. These include:
 Improving outcomes for your patients
 Demonstrating quality improvement for GP appraisal, revalidation and CQC
inspection
 Identifying patients for Significant Event Audits
 Providing opportunities for case study discussion and peer learning – for complex
cases
 Creating improvement plans from local feedback to improve patient care
 Highlighting diagnostic challenges and good practice
 Measuring clinical guideline impact
 Having your say to influence local commissioning decisions, strategic priorities and
inform service improvement
B. Time commitment
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1. How long will the audit take to complete?
Feedback from the pilot shows that on average, it takes 15 minutes per patient to complete
the audit requirements. However, this will obviously depend on the complexity of each
patient, the individual’s ability to navigate their clinical system and whether they are
accessing support to complete this audit.
2. Can I submit information as I go (patient by patient) or do I need to plan to do all of
this work in one go?
The data collection period last for a 3 month period from early September to end November.
GP practices can decide how best to undertake the audit work and whether to do some work
little and often and submit the details as they go along, or work in a concentrated manner
and submit in one go.
3. Do I have to audit all the patients or can I choose to do a sample of them?
We are asking practices to undertake the data collection on all patients registered to the
practices that were diagnosed in 2014. On average, this is about 8 patients per full time GP.
4. What do I need to at each stage of the audit?
There are various stages. Stage 1 – expressing an interest. GP practices will need to
express their interest in the audit. This can be done through the NCDA website.
Stage 2 – registration and verification process. The exact process is currently being
developed. However, GPs will the need to comply with verification process, in order for the
cancer registration service, which routinely collects hospital data on all cases of cancer, to
allow the GP access to data from all of their patients who were diagnosed with cancer in
2014.
Stage 3 - data collection, the National Cancer Registration and Analysis Service (NCRAS)
will give GPs access to their patients’ data. Participating GPs will then securely submit
information gathered on their patients from their clinical systems. Information will be
collected from the period of a patient first presenting with symptoms to their diagnosis,
including: consultations, key dates, investigations, symptoms and referrals. Information will
also be collected on patient characteristics such as ethnicity, reasons why patients might find
it difficult to communicate with a GP, attend the GP surgery and other health conditions.
Stage 4 - following analysis, a national report will be produced with local feedback for GPs,
along with further resources and tools. GP practices will then be in a good position to
undertake (if they wish) further clinical improvement activities, supported by CRUK Health
Professional Engagement Facilitators.
C. Clinical improvement
1. How is this going to help me improve my clinical practice?
Practices can use the information gathered during the data collection phase of the audit to
reflect on their clinical practice and practice based systems and processes. Some of the
insights this will provide include:
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 Types of delay
 Where delays occur
 Factors contributing to multiple consultations
 Impact of patient characteristics
 Overview of presenting symptoms by key tumour types to highlight complexities
 Presenting symptoms by place of presentation
They may wish to use the RCGP audit toolkit or undertake SEAs. Cancer Research UK
health engagement facilitators will be available to support local action planning with
practices.
2. Will the findings be available at a local as well as a national level?
Feedback will be available at a practice and CCG level, as well as national.
D. Support for practices
1. What support is available to me?
Support is available from various sources. Cancer Research UK’s health professional
engagement facilitators will offer support and advice to GP practices during the recruitment
phase. They will also check how practices are progressing during the data collection period.
Following the publication of the findings, in order to maximise local learning and
opportunities for clinical, the facilitators will work closely with practices.
E. Who needs to be involved?
1. I’m the only GP interested in doing this in our practice. Is that OK?
The audit is being undertaken on a practice basis as the NCRAS can only identify patients
diagnosed with cancer at practice rather than GP level. It is up to each practice how they
decide to take part in the audit – whether all GPs review their own patients, whether they
review each others’, or whether one GP leads on this on behalf of the others. However, the
practice will want to consider how it maximises this as an opportunity for local clinical
improvement and action planning.
2. Is it acceptable for GP registrars and medical students on placement with practices
to complete the audit?
One of the benefits of taking part in this audit, is that active clinical engagement in reviewing
the early diagnosis pathway will lead to improved outcomes. GPs will need to decide how
closely involved they wish to be in the exercise, in order to maximise any learning
opportunities during and following the audit. Anyone accessing the data from the cancer
registries will need to satisfy the verification process requirements.
3. Can practice managers do this audit or a member of the practice admin team?
One of the benefits of taking part in this audit, is that active clinical engagement in reviewing
the early diagnosis pathway will lead to improved outcomes. GPs will need to decide how
closely involved they wish to be in the exercise, in order to maximise any learning
opportunities during and following the audit. Anyone accessing the data from the cancer
registries will need to satisfy the verification process requirements. If a practice wishes to
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delegate the data collection to a non clinical colleague, they will need to be satisfied that the
individual concerns has good knowledge of medical terminology and is sufficient trained to
review clinical notes and apply judgement in order to answer the questions on the audit e.g.
whether a particular consultation represented a missed opportunity or not.
F. Information governance
1. Do we have to ask the patients’ permission?
No – this is not required as the audit will potentially impact on direct patient care for those
patients diagnosed with cancer, as well as patients in the future who present with signs and
symptoms relating to cancer.
2. What are the information governance arrangements for the audit?
Information governance and data release requirements will be met. A successful application
to the Office of Data Release is required before the audit can proceed. This application will
detail how information will be transferred securely between GPs and the cancer registry.
Public Health England will sign off the GP verification processes, so that it can be satisfied
that data is securely transferred. The principles of fair processing will apply, so a minimum
amount of data will be in order to answer the audit question, and the data will only be used
for the defined purpose of the audit. The data may, in the future, be used for further audit
and research purposes. However, appropriate approvals will be sought for any further
research.
3. Who will see this data?
Public Health England will be the data controller for this audit (responsible for the data).
Practices will receive feedback on their data.
G. Scope of the audit
1. What period does the audit cover?
All cancer diagnoses made in 2014.
2. How will practices know which patients to audit?
They will be identified by the registry (NCRAS) and given to the GP practice. On average,
this will be about 8 diagnosis per GP.
3. Will patients who were referred and treated privately be included?
It will be all patients with cancer diagnosed in 2014 – regardless of who referred or where
treated.
4. Does this include cancer referrals made by dentists?
This includes all diagnoses made in 2014 regardless of the referral route.
H. When should I do the data collection?
1. How long do we have for the data collection phase?
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Practices will have 3 months to complete the data collection, so it is up to them individually
to plan when they will do the data collection.
2. Can I do the data collection at home on my work laptop or must it be done from the
surgery premises?
GPs will need access to their clinical system to complete the audit, and they will need to
comply with their Information Governance good practice requirements. To satisfy Public
Health England’s data security requirements, GPs will need to complete the audit in a
location that has a N3 connection.
I. Data collection template
1. How has the data collection process been developed?
A pilot was undertaken to shape the data collection processes and to make the process as
smooth as possible for GP practices. In addition, user testing is to be completed, again, to
make sure that this is as easy for practices as possible.
In addition, there will be an IT helpdesk function and a data query management function.
The details of this will be shared in due course. Prior to the data collection going live,
practices will receive an information pack that includes further FAQs and a user guide for
completing the audit.
J. IT infrastructure and knowledge minimum requirements
1. What minimum requirements are there to take part in this audit?
GPs taking part in the audit will need access to their own clinical system, and be able to
access the data collection portal through a N3 connection. The data collection template has
been designed and user-tested to be as easy-to-use as possible. GPs will need to access an
NHS.net email in order to register and successfully complete the GP verification processes.
K. Further questions
1. If I have another question, who can help me?
You can ask questions, either via the CRUK Health Professional Engagement Facilitators, or
by visiting www.cruk.org/ncda where there is the facility to submit questions directly to the
NCDA team.
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