Quality improvement: Better outcomes for patients with cancer

Female Gp with patient

15 November 2019

Dr Richard Roope, RCGP and Cancer Research UK Clinical Champion for Cancer

The RCGP’s position statement on Quality Improvement (QI) states: 'All GPs strive to provide the best possible care for patients, families and communities...' This I am sure we can all sign up to, whether we are a 'First5' or a 'Last Five' or anywhere in between. GPs and their teams are all hugely stretched and have been for the last few years. Austerity has bitten hard, and most of us will only be too aware of the challenges of recruitment and retention, highlighted in the report King's Fund's report 'Closing the Gap' suggesting that recruiting an additional 5,000 GPs is only a start. 

Clearly, this will not happen overnight, so other strategies are needed to “close the gap”. One activity that can contribute to this is for practices to engage in QI. It ticks all the right boxes – it “helps primary care free up time to deliver and evaluate initiatives and embed new approaches more effectively and efficiently into practice. QI helps us to make the most of our systems, organisations, talents, and expertise to deliver better outcomes for patients.”

'Better care for our patients'

QI activity re-equips us to investigate and refer our patients, if indicated and where appropriate, at the right time, to the right place, to see the right colleague and so has the potential to reduce consultation numbers, and, at the same time deliver the better care for our patients.

Some of us will have been engaged with QI for a while, others will have just started – particularly in England, spurred on by this year’s additions to Quality Outcomes Framework (QOF) with two modules on ‘Prescribing Safety’ and ‘End of Life Care’. In the ‘Five-Year Framework for GP contract reform’, NHS England announced that they would develop a QOF Quality Improvement module on early cancer diagnosis for national use in 2020/21.

One option for practices to prepare for this is to sign up to the National Cancer Diagnosis Audit (underway in England, Scotland and Wales). Over 20% of English practices have already signed up, with over 10,000 cancer case reviews undertaken.

'Improving outcomes for patients with cancer'

With cancer causing more premature deaths in the UK than cardiovascular, respiratory and liver conditions combined, cancer care is a good place to start QI activity. Areas that could be 'rich seams' to review would be safety netting, for example, reviewing systems that might highlight if a patient defaults on having an investigation, and reviewing a delayed cancer diagnosis, to see how patient pathways might be improved. QI activity has the potential to improve the management of patients presenting with symptoms that could be caused by cancer. In turn it could contribute to better outcomes for patients and, for GPs in England, contribute to the goal set out in the NHS Long Term Plan to diagnose 75% of cancers at an early stage by 2028.

There are several College resources you may find helpful to make your working month just a little more stimulating and benefit your patients at the same time:

  1. Quality Improvement for General Practice
  2. Quality Improvement Toolkit for Early Diagnosis of Cancer
  3. RCGP QI Screencasts
  4. RCGP QI Ready


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