National Cancer Action Team

The Royal College of General Practice and NCAT worked with three academic departments to develop a standardised audit template for cancer to assist primary care in understanding delays in the diagnosis. In 2009/10 NCAT funded cancer networks to carry out audits using the template and a report analysing the results nationally is now available.

A significant event audit template was also developed and the results of its use for lung and child and adolescent cancers by practices in the North of England have been analysed.

The audit tools have been updated in the light of the research and are available free for use by practices.

For the audit template and report click here.

For the SEA and report click here

For experience of cancer networks in implementing the audits see this article.

For an article about using audits to gain CME points for GP appraisal click here

For local reports of completed audits see

North of England

Greater Midlands 

The NCAT GP Leadership/Practice Profiles Project in 2010/11 involved cancer networks supporting general practice to reflect on ways of speeding the diagnosis of cancer. Cancer networks are continuing to use the profiles as part of their 2011/12 Supporting Primary Care projects to help GPs reflect on their practices' performance and, in some cases, to identify practices for additional suppport,

Practice profiles have been produced by the National Cancer Intelligence Network (NCIN) for each practice, showing cancer incidence, type of referrals, screening rates and demographic and other data.

in 2010/11, NCAT-funded GP leads in each network encouraged practices to access and interpret their profiles and selecting some practices for additional support. These practices were funded to carry out an audit of recent cancer cases, to make any changes suggested by the findings and then to re-audit to examine the impact of the changes.

To access their data, practices had to sign a confidentiality agreement as the purpose is to benchmark themselves against others at practice, PCT and national level.

The project was flexible and GP leads adapted the work to suit local conditions [see article]. For instance, some GP encouraged practices to do audits to contribute to their revalidation requirements while others were promoting the project as a way of preparing practices for GP commissioning.

Information is available on the NCIN website 

Evaluation of the provision of practice-level cancer profiles to general practices: 2010 /11 executive summary and presentation of the results. For more information contact Kathy Elliott

For information about your area see Contact list: supporting primary care in Document Box 

Risk assessment tool training for GPs  

Cancer networks have been funded, through NCAT's Supporting Primary Care Projects, to distribute the RAT in the form of mousemats or a desk easel to general practice and to train GPs to use it. Networks received training in the RAT through an interactive webcast on 12 December. The following materials can be used and adapted by cancer networks for their training of GPs:

• The Hamilton risk assessment tools – what are they and how can we use them? Presentation by Professor Willie Hamilton, who developed the tools, for the training webcast
• RATs: initial evaluation Presentation for the training webcast by Professor Una Macleod, who evaluated the pilot use of the tools by seven cancer networks in 2011
• A list of freqently asked questions, includng the questions GP leads and others from cancer networks asked during the webcast
• A background paper describing the RAT and the main findings of the pilot.
• A 2 minute video on using the RAT from North West London Cancer Network

A summary of the evaluation of the pilot in seven cancer networks is available is available here and a slide presentation of the results here. The risk assessment tool was based on work done by Professor Willie Hamilton in the CAPER studies (Cancer Prediction in Exeter), a series of case-control studies which identified symptoms of common cancers that are presented to primary care and quantified the risk of cancer associated with them.

The tool acts as a reminder to GPs to consider the likelihood of an individual patient aged 40 or over having lung or bowel cancer given the symptom or combination of symptoms they present with. It is presented as three tables (colorectal cancer, lung cancer for non smokers and lung cancer for smokers) containing the risk values for each symptom in isolation or combination and is available as a mouse mat or a desk easel so as to be easy to hand.

Oxford University Department of Primary Health Care has worked with GPs and other clinicians to produce guidelines for practices on implementing safety netting for cancer diagnosis.

In the majority of cases, patients present with vague symptoms, which may not be enough by themselves to drive a referral. However certain patient characteristics, alongside one or more symptoms, raise the likelihood of malignancy.

Clinicians seem to agree that the main elements of safety netting are:

1. Communicating the existence of uncertainty
2. Outlining exactly what the patient needs to look out for
3. How to seek further help and
4. What to expect about time course.

The university has worked with 40 primary care cancer experts, GP cancer leads from the local cancer networks, and GPs who are not cancer leads to produce the guidelines and to rank them in order of importance.

Click here to see the report.

For more information contact Kathy Elliott kathy.elliott@ncat.nhs.uk    

A lung cancer campaign was piloted in Arden, Pan Birmingham, Greater Midlands and East Midlands Cancer Networks and parts of bordering networks Thames Valley, Three Counties, Anglia, North Trent and Greater Manchester. The Be Clear on Cancer campaign ran for five weeks from 10 October 2011.

NCAT supported the networks involved in the 2011 regional bowel campaign to work with primary care:

• describing the local problem using data from practice profiles and elsewhere
• information about the campaign such as target groups and key messages
• estimating the likely increase in presentations so services can prepare
• reinforcing the message about the importance of two week wait referrals.

The results of the evaluation of the bowel pilot are summarised at http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_128971

As part of this evaluation, some practices trialled the use of GP READ codes to track increases in patients presenting with possible bowel cancer symptoms.

For more information about the READ codes evaluation contact kathy.elliott@ncat.nhs.uk

For general information about the Be Clear on Cancer awareness campaigns see CRUK website http://info.cancerresearchuk.org/spotcancerearly/naedi/lungbeclearoncancer/ 

Three rounds of learning sets were held. Presentations and articles about the public health perspective on engaging primary care in cancer awareness are on the evidence and sharing learning page of this site. 

If you have experience to share or want to learn from others experience of engaging primary care in cancer awareness contact Sally.Williams@Frontlinemc.com

The initial learning sets for cancer networks focused on primary care and GP engagement and commissioning and sustainability. A second round, also looking at engaging GPs and primary care, was designed for PCT staff running the 59 2010/11 NAEDI projects managed by Cancer Research UK. An interim report of this round is available here.  

The learning sets focusing on primary care each began with a presentation from a cancer network director and a primary care lead about their experience of promoting awareness and early diagnosis. A guide, distilling their experience, is available here. Articles about the presentations and presenters' slides are available in the document box on the Evidence and Sharing Learning page of this site Click here 

For articles and reports about the learning sets on commissioning and sustainability Click here