South West Cancer Network
Colorectal Diagnostic Pathway Project
Brief description of project
This project aims to agree how to ensure that patients with colorectal problems (including suspected cancers) get the right first step on a diagnostic pathway within agreed timescales.
The diagnosis of colorectal cancer can be made following a number of different routes. In order to diagnose colorectal cancer earlier, more people will need to go through a diagnostic pathway, so that those with cancer are diagnosed at an earlier stage. However, the signs and symptoms of early colorectal can be subtle.
31% of colorectal cancers in the South West are diagnosed following an urgent referral but as many are diagnosed following a routine GP referral (22%) or other appointment (9%). As thresholds for some form of investigation drop, the distinction between urgent and non-‐urgent referrals becomes harder to manage. This is more critical as colonoscopy – the main first diagnostic test – carries an inherent risk to the patient and pathways have been created to manage this risk.
Work carried out across the South West (including significant event audits of those diagnosed following an emergency admission) indicates that the information received by providers with referrals may not be sufficient to enable the providers to select the appropriate first step – resulting in a clinic appointment or flexi-‐sigmoidoscopy by default. GPs have commented that pathways are designed from the perspective of knowing the patient has cancer and have an increasing burden of disease specific (rather than symptoms group specific) protocols and forms. Both sides agree that better communication between GP and secondary care would enable the right first step to be made for patients especially for those with the subtler signs of early colorectal cancer. In addition colorectal diagnostic services are under significant pressure – especially colonoscopy but also including outpatient capacity.
As a consequence to these pressures and constraints a variety of pathways operate in the South West with significant potential for more effective and efficient arrangements.
Aims, objectives & timescales of the project
The project aims to implement a consistent pathway across the South West and to identify the resources required to sustainably deliver against cancer waiting times targets. This will include:
• Straight to test & one stop clinics
• Merging of referral routes – urgent and standard pathways
• Create better pathways for patients with vague symptoms
This will mean that the thresholds for 2 week wait referrals will not need to be lowered.
The ambition is to introduce an “Advice & Guidance” system whereby patients are pulled by the colorectal teams into hospital and seen in agreed timescales. This will mean that “two week wait” referrals will no longer occur. This will free services to deliver more timely access to all patients with suspected colorectal disease whilst ensuring that the net waiting times for all colorectal cancer patients improves.
The project will be carried out from September 2014 to August 2015.
Planned outcomes & benefits
• Review current colorectal diagnostic pathways across the South West
• Agree consistent developments to individual pathways
• Implement new South West pathway – including use of ”Advice & Guidance”
• Assess capacity to deliver optimum pathway
• Assess impact of implementation including quality, patient experience and waiting times
Programme of Work Documents
Mark Rawles – South West Cancer Network Project Manager
Jon Miller – South West Cancer Network Manager