Primary Care Quality Improvement – CEG Cancer Diagnosis Audit Tool (CDAT) GP Update

Follow up to previous post of 11 March 2025: New LIS: CEG Cancer Diagnosis Audit Tool (CDAT) – North East London

Help us to help you improve early-stage diagnosis and achieve better outcomes for our patients. Only 56% of our patients were diagnosed at stage 1 and 2 in October last year. Taking part in this audit will help us to better understand pathways to cancer diagnosis, what works well and where local improvements could be made.

Focus on Late-Stage Diagnosis

Please complete the tool with as much information as possible for patients and cancer diagnosis to make the analysis and exercise as meaningful as possible. 

• Focus should be on the patients who have a late-stage diagnosis or delayed diagnosis (stage 3 and 4). For these patients, we expect some narrative in the final column outlining the reasons for their late-stage diagnosis, usually broken down in to patient, GP or secondary care factors

• In cases where the codes do not clearly describe a patient’s diagnosis or demographic information, clinicians are advised to manually check the patient record for uncoded information which would not be picked up by the tool.

• Do check dates when manually entering e.g. date symptoms first reported is likely to be before the date of diagnosis.

• There may be some patients included in the database with an old diagnosis (usually because there has been an incorrect ‘new’ cancer code in the last year – these patients can be omitted from analysis, but leave a comment

• Below are some good examples of reflective narrative received as part of the audit, where there is brief or no reflective narrative recorded for late stage or delayed diagnosis you will be asked to provide this before payment can be released.

Reflective Narrative Examples

• Initially cough was treated as due to pleural effusion. Once resolved was discharged, cancer wasn’t thought of as a differential. The patient had unresolved SOB and hyponatremia. The unspecified symptoms could have warranted a cancer referral. Also complained of back pain and significant weight loss later but not initially suggesting metastasis. (Stage 4 Lung)

• Complicated as already under oncology – multiple cancer diagnosis. Refused investigations earlier on, patient delays also a factor (Stage 4 Colorectal)

• As highlighted the need to have continuity of care to track results and follow up to avoid delays in diagnosis. This patient was seen by an ANP who asked for help from the duty doctor and the results were seen by the regular doctor who then intervened and contacted the patient to review them and arrange a 2ww referral (Stage 3 Lymphoma)

• Nil or No (Stage 4 lung cancer) – this will be challenged!

Reflection prompts

As a guide below are some suggested prompts to consider when completing the audit and reflecting on the patient journey.

• Were there any reasonable adjustments and provide examples like social, communication/physical health needs? As an example, a patient hoist needs were not noted, and this caused a delay in the cancer pathway.

• Were there any national screening programmes relevant to the diagnosed cancer? For example, did the patient participate in bowel cancer screening? It would be good to get an idea of whether an earlier diagnosis potentially could have been made.

1. If it is possible, capture if there were any pathway gaps, for example a patient DNAs an appointment would there be access and support from community learning disabilities team or consultant?

• Were there any obvious delays in the patient achieving an earlier diagnosis?

• Were there any obvious reasons for the patient’s late-stage diagnosis (stage 3 or 4)? Some examples are, were there delays due to lack of patient engagement, the hospital trust giving timely appointments, patients not added to safety netting when referred?

Need help or have questions?

Need some help completing the audit, running the tool or completing the claim form? Drop-in to one of the clinics below where you can ask questions and receive any additional support.

Contact Us

Please do get in touch if you have any questions or queries.  nelondonicb.nelcaprimarycare@nhs.net

Thank You