Welcome to ACE News - a quarterly round-up of activity from the ACE Programme. With the launch of the second wave of the programme this year, our blog (linked below) explores how the innovative Multidisciplinary Diagnostic Centres (MDC) concept aims to streamline routes to diagnosis for patients with vague symptoms.
Also included in this edition is our response to the recommendation of the new FIT test for bowel screening, the GP Good Practice Guide for bowel screening and the recent update to the Routes to Diagnosis analysis published by the National Cancer Intelligence Network (NCIN).
Please forward this newsletter to anyone you think might be interested in ACE, or they can sign up directly at ACEteam@cancer.org.uk
Multidisciplinary Diagnostics Centres concept
The ACE Programme is launching its second wave of pilots this year exploring the Multidisciplinary Diagnostic Centre (MDC) concept.
The six pilots, in London, Greater Manchester, Bristol, Leeds, Oxfordshire and Airedale aim to test how feasible this diagnostic pathway will be for the NHS in England. This blog published yesterday looks at the MDC concept in more detail and how it'll be tested through ACE.
The MDC concept originates from Denmark, where a patient with non-specific, concerning symptoms is referred to a centre for several diagnostic tests and assessed by different specialists in one place. Aiming to reduce the bouncing of patients between primary and secondary care to enable a faster diagnosis, the MDC is an innovative new model for the NHS.
GP Good Practice Guide for Bowel Screening in England
Cancer Research UK has recently produced the GP Good Practice Guide for Bowel Screening. This valuable resource for GPs and practices supports mainly primary care health professionals who want to be more proactive in how they can best support bowel screening uptake in their practice.
The guide has been developed with the help of Cancer Research UK facilitators, who visit over 1200 practices providing face-to-face practical support to GP practices to improve cancer outcomes.
The ACE Programme welcomes the UK National Screening Committee’s recent recommendation that the Faecal Immunochemical Test (FIT) replaces the faecal occult blood test (FOBT) as the primary screening self-test of the National Bowel Cancer Screening Programme (NBCSP). FIT will enable significant improvement in participation, as only a single sample has to be collected and analysed, compared to FOBT, which requires three. Given the large potential to catch cancers early and save lives, FIT should be rolled out as soon as possible.
The programme’s bowel screening cluster comprises projects from across England testing direct interventions to improve coverage and uptake in screening. The projects will contribute to the evidence base of what ‘effective interventions’ improve uptake.
The majority of projects are using enhanced primary care engagement and personalised GP endorsement as an enabler, to raise awareness and promote the benefits of regular screening especially in socioeconomically deprived communities. Engagement with project stakeholders is strong, and ultimately, all are working in partnership with localities to reduce health inequalities in defined communities and general practice populations.
The projects will be subject to a rigorous evaluation led by the Department of Health Policy Research Unit, ensuring that evidential learning is collated and shared across the wider NHS. Initial outputs from the projects to date are practical and descriptive, including materials for sharing, such as protocols and good practise guidance. At this stage, ACE projects are demonstrating that personalised endorsement and support from GPs, and working in collaboration with the centralised screening hubs seems to have the most effective operational impact on improving screening uptake.
At the early stage of output, demonstrating personalised endorsement and support from GPs, and working in collaboration with the centralised hubs of the NBCSP, appear to have the most effective operational impact on improving screening uptake.
ACE will produce a list of practical recommendations shortly, based on the evidential learning of ‘what works best’ for consideration by the National Screening Committee in the design and implementation of the FIT delivery model.
NCIN publishes Routes to Diagnosis study
The National Cancer Intelligence Network has recently publishedtwo updatesto the Routes to Diagnosis study and analysis. Using various datasets, every case of cancer registered in England between 2006 and 2013 is categorised into one of eight ‘routes to diagnosis’.
The outputs from the study include key incidence and survival statistics, allowing the user to select the cancer type of interest, the year of diagnosis or the survival period. The data can also be split into results by Strategic Clinical Network (SCN) and four cancer sites by Clinical Commissioning Group (CCG).
Encouragingly, the new analysis shows that cancers diagnosed as an emergency presentation have decreased from 24% in 2006 to 20% in 2013. However, much more work needs to be done to ensure that everyone can be tested and diagnosed at an earlier stage. Approximately half of cancers diagnosed in emergencies present with vague symptoms, and we are hoping the MDC model tested through ACE Wave 2 has an impact on emergency presentations and subsequently on patients' standard of care.