NHS England recently announced changes to the cancer waiting times standards that will come into effect from 1 October 2023, supporting the NHS Long Term Plan objectives to improve early cancer diagnosis and cancer survival.
The current list of 10 standards will be consolidated into just three, to “reflect what matters most to patients and to align with modern clinical practice”.
The new standards will not change the way that GPs refer patients with suspected cancer. However, they will provide clarity for patients, and provide impetus to improve performance in the cancer diagnostic and treatment pathways.
GPs will need to understand the new standards and explain them to anxious patients with suspected cancer who have questions about the next steps in their care.
The new cancer waiting time standards
The new standards come with broad support from clinical experts and cancer charities. They follow on from an extensive review led by Professor Sir Stephen Powis, national NHS medical director, and take into account the recommendations of the 2015 Independent Cancer Taskforce to abandon the outdated two-week wait target.
The three key standards are:
- 28-day Faster Diagnosis Standard (initial target 75%): people should have cancer ruled out or receive a diagnosis within 28 days of an urgent referral by a GP for suspected cancer, following an abnormal cancer screening result, or by a GP for breast symptoms where cancer is not suspected.
- 62-day referral to treatment standard (initial target 70%): people with cancer should begin treatment within 62 days of an urgent referral by a GP for suspected cancer, following an abnormal cancer screening result, or by a consultant who suspects cancer following other investigations.
- 31-day decision to treat standard (96% target): people who have been diagnosed with cancer should begin treatment within a month of a decision to treat their cancer.
Furthermore, hospitals will be asked to work towards a 10-day turnaround for delivering diagnostic test results.
Focus on the Faster Diagnosis Standard
The 28-day Faster Diagnosis Standard, in use since April 2021, puts the focus on people receiving a diagnosis of cancer or having cancer ruled out within 28 days of a GP urgent referral – a much more relevant measure for patient outcomes than the two-week wait target for a first appointment with a specialist.
The focus on faster diagnosis will enable wider and more efficient use of new technologies for diagnosing and treating patients, such as the use of artificial intelligence and teledermatology in the diagnosis of skin cancers, one-stop clinics for examination and biopsy of suspected breast cancer, and faecal immunochemical tests in suspected colorectal cancer.
Clarity for primary care patients
The focus on three clear and clinically-relevant standards will make it easier for GPs to explain to patients what to expect when they are urgently referred for suspected cancer: diagnosis or cancer ruled out within one month and cancer treatment started within two months.
As explained by Dr Amelia Randle, Clinical Director for Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance, “Being referred for a suspected cancer is an uncertain and worrying time for people, many of whom will not be diagnosed with cancer.”
“Since the introduction of the 28-day Faster Diagnosis Standard I have been better able to discuss with patients what to expect and the timescales involved – getting a speedy diagnosis is what matters to them so this is a much more relevant measure than the two-week wait. Those who do need treatment have had a co-ordinated start to their journey and are able to access high-quality, compassionate care in a timely way.”
Can the targets be achieved?
Current statistics show that every waiting time target is being missed, meaning anxious delays for many patients. With the new standards, NHS England has confirmed a renewed focus on supporting services to improve performance.
Expectations are that by March 2024, the Faster Diagnosis Standard will be achieved for 75% of patients and the 62-day referral to treatment standard will be achieved for 70%. However, NHS England aims to raise these targets, expecting the Faster Diagnosis Standard to be met for 80% of patients in 2025/26. For the 62-day standard, the eventual target is 85%, but the ongoing impact of strike action and patient backlogs may influence the time it takes to reach this goal.
Additional resources for primary care
- NICE: Latest guidelines for suspected cancer recognition and referral
- Best practice timed diagnostic cancer pathways: NHS England summary guidance on meeting the Faster Diagnosis Standard for common cancers
- Royal College of GPs primary care cancer toolkit
Please get in touch with our expert advisors at Medical Defense Society if you have questions or concerns about patient referral for suspected cancer.