Recommendation 2

HM Government Acknowledged

• Faster Diagnosis Non-Specific Symptom pathways are transforming the way that people with symptoms not specific to one cancer, such as weight loss or fatigue, are diagnosed or have cancer ruled out. This gives GPs a much-needed referral route, while speeding up and streamlining the process so that, where needed, people can start treatment sooner. Despite the wider pressures created by the pandemic, significant progress has been made. There are 84 pathways already live – up from 12 live Rapid Diagnostic Centre pathways in March 2020. From May 2020 to February 2022, over 34,700 people were referred on a non- specific symptom pathway. • NHS Operational Planning Guidance for 2022/23 has set specific expectations including: ◆ extending coverage of non-specific symptom pathways – with at least 75% population coverage by March 2023; and, ◆ ensuring at least 65% of urgent cancer referrals for suspected prostate, colorectal, lung, oesophago-gastric, gynaecology and head and neck cancer meet timed pathway milestones. • Community Diagnostic Centres (CDCs) offer checks, scans and tests, in community and other health care settings, scaling up since July 2021. • CDCs collectively delivered over 880,000 diagnostic tests in 2021/22, which represents a full year effect of 1.7m. • £2.3bn capital funding is being invested in the roll out of CDCs and digital diagnostics, with targeted funding for imaging and endoscopy in acute trusts, plus lung and breast screening. Systems have been able to access dedicated revenue funding to support the set up and running of CDCs since 2021/22 and will continue to do so in 2022/23, 2023/24 and 2024/25.Supporting timely presentations. • Helping people to understand the signs and symptoms of cancer and encouraging them to act on them remains a core pillar of our strategy to diagnose cancers at an earlier stage. In 2021/22, NHSE/I invested more than ever before in awareness campaigns which included awareness campaigns focused on abdominal and lung cancer symptoms, as well as trialling the new campaign to persuade people to overcome their reluctance to contact their GP. This blended approach is likely to form the blueprint for future campaigns. • Our case-finding initiatives and public awareness campaigns are paying off – GPs are referring more people for urgent cancer checks than ever before – more than 200,000 every month. • A joint campaign with Prostate Cancer UK (PCUK) ran through February and March 2022 with over 550,000 people having used the PCUK risk checker to date – those at high risk are encouraged to see their GP. NHS EI’s approach to working with primary care in support of earlier diagnosis is based around three key priorities: • Streamlining and incentivising effective referral • Harnessing the reach of primary care to case find • Creating and extending new routes into the system. There is a range of activity underway to help drive this forward. were published in March 20221. These updated requirements focus the cancer work of Primary Care Networks on supporting the continued recovery of cancer services from the Covid-19 pandemic and accelerating delivery of our NHS Long Term Plan commitments. 1 https://www.england.nhs.uk/wp-content/uploads/2022/03/B1357-Network-Contract-Directed-Enhanced-Service- contract-specification-2022-23-primary-care-network-requireme.pdf commitments aligned to NHS Planning Guidance and include several requirements targeted at improving referral practice. These are: the use of Faecal Immunochemical Test (FIT); expanding the use of teledermatology; and, extending coverage of non-specific symptom pathways. In addition, the use of FIT to reduce demand on endoscopy capacity has been incentivised in the GP contract for 22/23. From 1 April 22/23 GP practices were financially incentivised for the proportion of their lower gastrointestinal FDS referrals accompanied by a FIT result, supporting the aim of ensuring that 80% of referrals on this pathway are accompanied by a FIT. NHS EI will trial new approaches, starting with prostate cancer. This pilot will build on the contractual requirement to develop and implement a plan to increase the proactive and opportunistic assessment of patients for a potential prostate cancer diagnosis and will evaluate the impact that proactive case finding has on early diagnosis. NHS EI is looking to create and expand new routes into the system across the wider primary care community. For example, pharmacies are well placed to spot people presenting with “red flag” potential cancer symptoms during a healthy lifestyle intervention, when they come to buy medicine or pick up a prescription, or when they visit a pharmacy seeking advice. act on potential cancer symptoms. NHS EI is also continuing to pilot self-referral services which establish new routes into the system for people with suspected cancer, following telephone assessment. Several pilots are due to go live in early 2022/23.