Earlier this month, NHS Resolution published its report on general practice indemnity claims and delayed cancer diagnoses, which has been described by the SoR as an essential read.
The report, Delayed diagnosis of cancer: a thematic review of general practice indemnity claims, identified three key areas for improvement of diagnostic processes and the cancer care pathway overall.
These included optimising diagnostic processes, enhancing communication within consultations and across the healthcare system, and empowering patients through increased self-referral pathways and escalation mechanisms.
Better coordination of care
With contributions from the SoR, the report highlights the important role of diagnostics in supporting patients and the critical contributions of radiographers and radiologists.
NHS Resolution is an arm's-length body of the Department of Health and Social Care, providing expertise on resolving concerns and disputes fairly. This latest report emphasises the difficulties associated with referral of patients onto a cancer diagnosis pathway, and what could be done to better coordinate care.
The report identified that:
- 65.7 per cent of patients were diagnosed with stage 3-4 cancer, compared to national early diagnosis rates of around 54 per cent for stages 1-2
- 40 per cent of cancer diagnoses were made following routine referrals or emergency department attendance, rather than urgent suspected cancer referrals
- Remote consultations featured in 53 per cent of claims, highlighting the increased importance of comprehensive history taking when physical examination is not possible
- 73.5 per cent of claimants aged under 50 years were female, indicating potential gender disparities in early-onset cancer detection
Rectifying missed opportunities
With GPs referring people on suspected cancer pathways in record numbers, millions more people are being diagnosed with and beginning treatment for cancer in England than ever, the report explained. While the majority of these are safe, the delayed diagnosis of cancer crosses many care sectors.
This report highlights that in general practice, there may be missed opportunities to identify suspected cancer in order to make an urgent referral.
To rectify these missed opportunities, the report makes three recommendations for the diagnostic process, specifically, including:
- Optimise use of diagnostic imaging support tools and transparency of diagnostic appointments and reporting times
- Optimise the use of non-specific symptom (NSS) pathways in primary care
- Review multidisciplinary training standards for remote consultation and triage
'Embracing a systems approach'
Sue Johnson, professional officer for clinical imaging at the SoR, said: “Embracing a systems approach is key to enhancing diagnostic processes, as we all understand that we can't prioritise every referral. However, ensuring we prioritise the right ones is ever more crucial and working in partnership with patients and referrers is essential.”
The indispensable role of radiographers in cancer detection means there is an urgent need for systemic improvements, she added.
Workforce pressure significantly affects appointment delays and report turnaround times, so the SoR is encouraging members to share their successes and support each other to make improvements. However, this challenge also encourages a shift towards workforce transformation.
'Maximising efficiency'
Sue continued: “We must ensure that radiographers operate to their full potential by embracing all dimensions of the career framework, extending beyond just advanced practice to include support and assistive roles in service delivery, which will maximise our efficiency and potentially positively impact patient outcomes.”
The report analysed 105 closed settled claims relating to delayed cancer diagnosis in general practice, notified over a seven-year period, up to March 2023. “Closed” means the claim has been completed and is no longer active. Claims data represent a small fraction of the millions of consultations delivered in general practice annually and do not capture all instances of delayed diagnosis.
To access the report in full, click here.
(Image: Photo via NHS Resolution)