Faster diagnosis

Faster Diagnosis Framework and the Faster Diagnostic Standard

Faster Diagnosis is fundamental to achieving the Long Term Plan (LTP) ambitions for cancer. The NHS Cancer Programme has developed a Faster Diagnosis Framework, which sets out NHS England and Improvement’s strategic approach to speed up cancer diagnosis and improve patient experience. 

Previously, a range of objectives relating to the faster diagnosis of cancer have existed across a number of separate programmes, including rapid diagnostic centres, the Faster Diagnosis Standard and Best Practice Timed Pathways. The Faster Diagnosis Framework now brings together the objectives and key requirements for cancer alliances under a single programme of work. 

Aims

The Faster Diagnostic Framework aims to deliver: 

  • an earlier and faster diagnosis for patients, whether or not they are diagnosed with cancer 
  • excellent patient experience, a holistic assessment of patient needs, and streamlined support across community, primary and secondary care 
  • increased capacity in the system, through more efficient diagnostic pathways 
  • support to healthcare providers to reach the Faster Diagnosis Standard.

The Faster Diagnosis Framework comprises three elements, including:  

  • the non-specific symptoms pathway 
  • best practice timed pathway implementation, which will include working with cancer alliances and integrated care systems (ICSs) and regional diagnostics programmes to ensure sufficient capacity is available, and 
  • a series of improvements across all pathways, regardless of cancer type .

For more information, please see the Faster Diagnosis Framework.  

Useful resources

Faster Diagnosis Standard 

Overview

The Faster Diagnosis Standard has been introduced to ensure patients who are referred for suspected cancer receive a timely diagnosis. 

Following an initial recommendation in the 2015 report of the Independent Cancer Taskforce, reaffirmed in the NHS Long Term Plan, the standard ensures patients will be diagnosed or have cancer ruled out within 28 days of being referred urgently by their GP for suspected cancer. For patients who are diagnosed with cancer, it means their treatment can begin as soon as possible. For those who are not, they can have their minds put at rest more quickly. 

The Faster Diagnosis Standard will apply to patients: 

  • referred by their GP on a suspected cancer pathway
  • referred by their GP with breast symptoms where cancer is not initially suspected
  • referred by the National Screening Service with an abnormal screening result. 

Aims

The Faster Diagnosis Standard will: 

  • reduce the time between referral and diagnosis of cancer
  • reduce anxiety for patients, who will receive a diagnosis or an ‘all clear’ but do not currently receive this message in a timely manner
  • work alongside the delivery of the 62-day referral to treatment cancer waiting times standard, including the standard to reduce waiting times, through improved analysis and pathway improvements of faster diagnosis 
  • cntribute towards the NHS Long Term Plan commitments for earlier diagnosis, including that, by 2028, 55,000 more people each year will survive their cancer for five years or more, and 75% of people with cancer will be diagnosed at an early stage (stage one or two). 

 Non-Specific symptom pathways

Non-specific symptoms pathways are intended to cover the cohort of patients who do not fit clearly into a single ‘urgent cancer’ referral pathway, but who are nonetheless at risk of being diagnosed with cancer. ‘Non-specific’ symptoms include unexplained weight loss, fatigue, abdominal pain or nausea; and/or a GP ‘gut feeling’ about cancer.  

 Previously, these patients may have: 

  • seen their GP several times before referral 
  • been more likely to attend in an emergency setting, such as a hospital accident and emergency department 
  • presented with cancer at an advanced stage
  • been referred onto multiple urgent pathways. 

Since 2019, cancer alliances have been developing new dedicated urgent diagnostic pathways for these patients so that every cancer patient with concerning, but non-specific symptoms, gets the right tests at the right time in as few visits as possible.  

By March 2024, we aim to ensure that all patients with non-specific symptoms will be referred via a non-specific symptoms pathway.  

Non-specific symptoms pathways can be based in primary care, run by GPs, or in hospitals as a consultant or nurse-led service. Patients referred have a comprehensive history taken, including details of their symptoms, and will usually receive a range of tests, including blood tests, chest X-ray, CT scan and endoscopy to rapidly progress them to the most appropriate diagnostic and treatment pathway. Less than 7% of patients referred to non-specific symptoms pathways receive a cancer diagnosis, with around 45% having a non-cancer condition diagnosed without having to be referred back to their GP. 

Best practice timed pathways 

 Since 2018, expert clinical ‘task and finish’ groups have developed best practice timed pathways  to meet the Faster Diagnosis Standard. These best practice timed pathways aim to shorten cancer diagnosis pathways by identifying specific clinical events and tests for patients referred with certain symptoms. By delivering these timed pathways, we will support healthcare providers in delivering high quality patient care, reducing variation among patients accessing diagnostics and improving treatment options and outcomes.  

To support healthcare providers, NHS England published four national best practice timed pathways handbooks in 2018/2019. The pathways aim to support improvements in operational performance and patient experience, as well as providing models to support sustainable improvement. We are developing BPTPs for gynaecology, head and neck, skin, urology, hepato pancreatic billary, and breast, which will be published alongside the existing national best practice timed pathways handbooks. We are aiming to have best practice timed pathways in place for all cancer pathways by the end of 2023/24. 

Experience of care

NHS England is committed to making sure having a good experience of care is a priority and always thought about alongside clinical effectiveness and safety. In 2020, a set of 32 quality markers were developed with patients, staff and unpaid carers to guide local systems on how to give the best experience of care when diagnosing cancer. Cancer alliances with providers and people who use their services, have been asked to assess their own services against the quality markers to improve experience of care. More information, including the full list of the 32 quality markers, can be found in the Faster Diagnosis Framework.  

For information on wider experience of care work please visit our cancer experience of care pages.