Assessing the impact of an English national initiative for early cancer diagnosis in primary care.
BACKGROUND
The Cancer Networks Supporting Primary Care programme was a National Health Service (NHS) initiative in England between 2011 and 2013 that aimed to better understand and improve referral practices for suspected cancer.


METHODS
A mixed methods evaluation using semi-structured interviews with purposefully sampled key stakeholders and an analysis of Cancer Waiting Times and Hospital Episode Statistics data for all 8179 practices in England were undertaken. We compared periods before (2009/10) and at the end (2012/13) of the initiative for practices taking up any one of four specified quality improvement initiatives expected to change referral practice in the short to medium term and those that did not.


RESULTS
Overall, 38% of general practices were involved in at least one of four quality improvement activities (clinical audit, significant event analysis, use of risk assessment tools and development of practice plans). Against an overall 29% increase in urgent cancer referrals between 2009/10 and 2012/13, these practices had a significantly higher increase in referral rate, with reduced between-practice variation. There were no significant differences between the two groups in conversion, detection or emergency presentation rates. Key features of successful implementation at practice and network level reported by participants included leadership, organisational culture and physician involvement. Concurrent health service reforms created organisational uncertainty and limited the programme's effectiveness.


CONCLUSIONS
Specific primary care initiatives promoted by cancer networks had an additional and positive impact on urgent referrals for suspected cancer. Successful engagement with the programmes depended on effective and well-supported leadership by cancer networks and their general practitioner (GP) leads.
School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK.
G
G
Rubin
PHE Knowledge and Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK.
C
C
Gildea
PHE Knowledge and Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK.
S
S
Wild
Care Quality Commission, 103-105 Bunhill Row, London EC1Y 8TG, UK.
J
J
Shelton
School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK.
I
I
Ablett-Spence
D055088:Early Detection of Cancer; D004739:England; D006801:Humans; D008485:Medical Audit; D009369:Neoplasms / Q000175:diagnosis*; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D012017:Referral and Consultation; D013222:State Medicine