Faster cancer diagnosis is a key ambition of the NHS Long-term Plan, which says that the proportion of cancers diagnosed at stages one and two should rise from around half now, to three quarters of cancer patients by 2028.
Raising greater awareness of the symptoms of cancer, lowering the threshold for referral by GPs, accelerating access to diagnosis and treatment and maximising the number of cancers identified through screening will be key to achieving this goal.
The Long-term Plan gives the 19 Cancer Alliances – groups of cancer clinicians responsible for driving the development of cancer pathways at a local level – a central role.
The Cancer Alliances will advise Sustainability and Transformation Partnership (STP) and Integrated Care System (ICS) board members on cancer services and help to ensure that local cancer strategies are delivered.
Cancer Alliances have also been tasked with helping the NHS to achieve a new faster diagnosis standard. The standard, which will be introduced from 2020, is designed to ensure that most patients receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening.
In addition, Cancer Alliances will also implement a new timed diagnostic pathway for specific cancers, building on the timed pathways already being introduced in lung, colorectal and prostate cancer.
Rapid Diagnostic Centres (RDCs)
Rapid Diagnostic Centres (RDCs), which were originally launched in pilot form in 2018, will underpin a radical overhaul of the way in which diagnostic services are delivered for patients with suspected cancer.
RDCs comprise multi-disciplinary teams which provide a single point of access to a diagnostic pathway for all patients with symptoms that could indicate cancer. These symptoms can be non-specific.
In addition to supporting the faster diagnosis standard, RDCs will complement work to improve screening programmes, augment the potential of artificial intelligence (AI) and genomic testing, and utilise Primary Care Networks (PCNs) to improve early diagnosis in their localities.
The success of RDCs will depend on corralling many disparate resources in the NHS – including GPs, who will form a big part of the service as they will refer patients with suspected symptoms to RDCs, supported by the local Cancer Alliance’s clinical network.
The 10 pilot RDCs are mostly clustered around the cancer vanguard areas of London and Manchester, with five in London, two in Manchester and one each in Leeds, Oxford, and Airedale, in the north west of England.
In 2019/20, all Cancer Alliances are expected to set up at least one RDC for patients with non-specific symptoms which could indicate cancer; as well as for a cohort of patients with site-specific symptoms who are currently served by an underperforming two week wait or 62-day pathway.
Primary Care Networks (PCNs)
As the NHS aims to move more care out of hospitals, PCNs are expected to play an important role in transforming cancer services. Indeed, the Long-term Plan states that PCNs will be required to help improve early diagnosis of patients in their neighbourhoods by 2023/24. In line with this, early cancer diagnosis is one of seven new service specifications that PCNs must deliver and it is due to start by April 2020.
We expect to see multi-disciplinary teams working within PCNs to deliver cancer services and this could mean more cancer specialists, such as cancer nurses, working in the community, as well as other specialists, such as gastroenterologists.
Screening and diagnostic services will be increasingly provided in the community, where pilot schemes such as ‘MOTs for lungs’ and on-the-spot scans for patients at high risk of developing lung cancer, have shown the value of bringing these kinds of services closer to patients’ homes.
We can also expect to see some chemotherapy services, previously owned by NHS England, begin to become the responsibility of ICSs, particularly homecare services.
The Long-term Plan says that the NHS wants to use personalised and risk stratified screening and begin to test family members of cancer patients if they have an increased risk of the disease. It is likely that PCNs will be tasked with quizzing patients about their family history in order to gather data that will support this proactive approach.
Gathering and analysing population health data around screening, including factors that deter patients from engaging with it, is invaluable for planning services. For example, most lung cancer diagnoses are made at stage four. However, research by Wilmington Healthcare shows that the chances of a patient being proactive about getting symptoms checked is affected by factors ranging from levels of deprivation in the local community to the quality of screening services.
Local or regional system empowerment is crucial for transforming NHS cancer services and so is integrated care; hence the work of Cancer Alliances and RDCs will be entwined within ICSs and PCNs. This localised, targeted, population health approach will play an important role in delivering key aspirations within the Long-term Plan.