BackgroundContinual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this.AimTo characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit.Design and settingClinical audit of cancer diagnosis in general practices in England.MethodInformation on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management.ResultsData were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more.ConclusionThe findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer.

Objective To characterize cancer diagnosis in Scottish primary care and draw comparisons with cancer diagnostic activity in England. Method A national audit of cancer diagnosis was conducted in Scottish and English general practices. Participating GPs collected diagnostic pathway data on patients diagnosed in 2014 from medical records. Data were supplemented by linkage to national cancer registries. Analysis explored and compared patient characteristics, diagnostic intervals, and routes to diagnosis. Results 7.7% of all Scottish general practices in 2017 provided data on 2,014 cancer diagnoses. 71.5% of cases presented to GPs and 37.4% were referred using the “Urgent‐Suspected Cancer” route. The median primary care interval was 5 days (IQR 0‐23 days) and median diagnostic interval was 30 days (IQR 13‐68). Both varied by cancer‐site. Diagnostic intervals were longer in the most remote patients and those with more comorbidities. Scottish and English samples corresponded closely in key characteristics. Conclusions Most people diagnosed with cancer in Scotland present to a GP first. Most are referred and diagnosed quickly, with variations by cancer‐site. Intervals were longest for the most remote patients. GPs in Scotland and England appear to perform equally but, in view of growing differences between health systems, future comparative audits may be informative.

Background: Timely diagnosis of cancer in patients who present with symptoms in primary care is a quality improvement priority. Aim: To examine possible changes to aspects of the diagnostic process and its timeliness before and after publication of the 2015 NICE Guideline for the referral of suspected cancer in primary care. Design and setting: Population-based clinical audits of cancer diagnosis in general practices in England for patients diagnosed in 2018 or 2014. Method: GPs in 1878 (2018) and 439 (2014) practices collected information on cancer patients. Data included patient characteristics, place of presentation, number of consultations, use of primary care investigations, referral type and perceived avoidable diagnostic delays. Results: Among 64 489 (2018) and 17 042 (2014) records of a new cancer diagnosis, the percentage of patients with same-day referral (denoted by a primary care interval of 0 days) was higher in 2018 (43% vs. 38%) with similar changes in median diagnostic interval (36 days vs. 40 days). Compared to 2014, fewer patients had 3+ consultations before referral (19% vs. 26%). Use of primary care investigations increased (48% vs. 45%). Urgent cancer referrals increased (55% vs. 52%) while emergency referrals decreased (13% vs. 17%). Recorded use of safety netting was lower (40% vs. 44%). Conclusion: In a 5-year period including the year when national guidelines were updated, there were substantial improvements in the diagnostic process of patients who present to general practice in England with symptoms of a subsequently diagnosed cancer.

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