Primary care networks (PCNs) may wish to review their referral practice against the recommendations of NICE guideline 12. Reviews can take the form of:

• undertaking an audit internally using the National Cancer Diagnosis Audit (NCDA) patient proforma and NCDA data collection template (The National Cancer Audit will not run in 2023-24)
• undertaking a Learning Event Analysis where a patient was diagnosed with cancer following a routine referral, an emergency presentation, or at a late stage (stage three or four)
• using Office for Health Improvement and Disparities (OHID) Fingertips data, which provides data on cancer services at practice and PCN level
• in-house evaluations, audits, or questionnaires on GP use of clinical decision support tools to help with decision making and clinical practice.

Actions to help increase uptake in cervical and bowel screening could include:

• continuing to review local and cancer screening data, available on OHID Fingertips and the NCL ICB PCN cancer dashboard to understand any variance in screening uptake
• working with NHS England Regional Public Health Commissioning teams to identify which screening programmes to focus on
• promoting screening via media including websites, patient information leaflets, Accurx and Dr IQ
• auditing non-responders to understand why uptake may be low
• continuing to use the Cancer Research UK Good Practice Guide and the Macmillan Cancer Screening Toolkit
• using the resources available on Screening Saves Lives
• offering extra clinics across a geographical footprint for those who find it challenging to access NHS cervical screening sample taking
• supporting national campaigns such as the Help Us Help You bowel screening campaign.

The use of faecal immunochemical tests (FIT) in those with NG12 colorectal cancer symptoms (excluding anal/rectal mass or anal ulceration) should be used to inform referrals. It is expected those with a FIT result fHb <1 0μg Hb/g, a normal full blood count and no concerning symptoms are safety netted in primary care or referred on a non-urgent pathway where appropriate. Visit the FIT service page for more information.

Cancer alliances have funding to support FIT implementation, which can be used to purchase FIT kits.

See also:

• The British Society of Gastroenterology’s (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidance on use of FIT in patients with signs or symptoms of suspected colorectal cancer
• NHS England’s system letters on FIT implementation, which provide practical support and information to help systems adopt the BSG and ACPGBI guidance.

See the guidance published by the British Association of Dermatologists and the NHS on new models of service for teledermatology. See also the best practice timed pathway for skin referrals.

New technology, such as teledermatology, digital referral platforms and the use of remote consultations via Consultant Connect can reduce the need for unnecessary hospital attendances, improve the speed of diagnosis for patients, and improve productivity while providing the same level of access to high-quality care, diagnostics and treatment.

It is expected that cancer alliances will deliver referral activity that reflects at least 75% population coverage of non-specific symptom pathways by March 2023. For more information, see the Rapid Diagnostic Centres service page.

See also the NHS Cancer Programme Faster Diagnosis Framework.

PCNs should:

• work with local partners (e.g. cancer alliances, commissioners) to understand the non-specific symptom pathways available in their areas and the model for referrals
• identify and undertake specific actions to encourage practices to refer using their non-specific-symptom pathway, where available and appropriate
• raise awareness of the non-specific symptom pathways within practices.