The ACE Programme is piloting a new diagnostic pathway, for patients with ‘non-specific but concerning symptoms’, which incorporates a Multidisciplinary Diagnostic Centre (MDC).Learn more
ACE seeks to develop the knowledge base on early diagnosis in order to identify and evaluate good practice, which can reduce system delays and improve early diagnosis of cancer. ACE supports the NHS outcome 'preventing people from dying prematurely'.
The ACE programme: accelerates progress, coordinates implementation and consistently evaluates best practice and innovative approaches to early diagnosis of cancer.
The ACE Programme is piloting a new diagnostic pathway, for patients with ‘non-specific but concerning symptoms’, which incorporates a Multidisciplinary Diagnostic Centre (MDC).Learn more
Direct referral by non-GP primary care health professionals: community pharmacists and optometrists
The report explains the rationale for the projects and how their direct referral pathways were developed and implemented. Key findings include the importance of effectively engaging all relevant local health economy partners and stakeholders and making sure that staff undertaking interventions have the right training.
Pharmacy training for early diagnosis of cancer
The report looks at how to best to organise pharmacy staff training for participating in early diagnosis related activities, including format and content and the costs involved. The report analyses five community pharmacy training programmes, including two ACE projects. Key findings include that counselling skills training for pharmacy counter assistants are crucial and that pharmacists must be required to undergo specific training in order to undertake direct referral of patients to secondary care.
The ACE programme aims to develop the knowledge base on early diagnosis by evaluating and sharing good practice, to inform future commissioning of cancer services.
ACE has two key aims: help NHS organisations implement best practice, including identifying and tacking system blocks, and test innovative ideas such as streamlining current pathways and developing new pathways for vague but concerning symptoms.
ACE seeks to drive:
Improvements in overall patient experience
For more information about how the ACE programme was developed, please download this PDF.
The Senior Responsible Officer (SRO) for the ACE programme is the NHS England National Clinical Director for Cancer, Chris Harrison. The programme is in the NHS England Early Diagnosis work stream which reports to the Cancer Transformation Board. Rosie Loftus, joint Chief Medical Officer represents Macmillan on the Cancer Transformation Board.
ACE is funded by Cancer Research UK, Macmillan Cancer Support, NHS England and the Department of Health's Policy Research Units. As ACE provides only limited financial support to projects, the majority of project funding has come from local, mostly NHS sources.
For more information on ACE funding, please download this PDF.
England lags behind comparable European countries when it comes to cancer outcomes including one- and five-year survival rates, more details of which can be found in the international cancer benchmarking initiative.
One key factor for poorer cancer outcomes is late diagnosis, namely too many patients being diagnosed at later stages of cancer when treatment options can be limited, more onerous for the patient, and may no longer be curative. Improving early diagnosis therefore has the potential to drastically improve cancer outcomes.
Late stage diagnosis happens for a number of reasons including late presentation by patients and system delays including in referral to secondary care or for diagnostic tests. The ACE programme focuses on addressing system delays including the development and evaluation of new streamlined diagnostic pathways.
Other initiatives, such as 'Be Clear on Cancer', seek to raise public awareness and understanding of the signs and symptoms of cancer, to encourage people to present to their GP when they first notice symptoms that may be cancer.
There are 54 projects within Wave 1 of the ACE Programme. These projects are organised into eight areas of work, which are referred to as ‘clusters’. Grouping projects together in this way has allowed project leads to share best practice on implementation with similar projects, and share data and outputs when they become available.
The projects in this cluster are exploring different ways to encourage people to undertake bowel cancer screening to increase screening uptake. A number of the projects include direct contact from GPs to individual patients.
It is hoped that the cluster can identify which methods of encouraging uptake work best, and how those methods can be implemented in a sustainable way.
In order to achieve higher bowel screening rates towards the national standard for patients, practices are chasing non-responders of screening invitations by letter/phone. Each practice will do a search of annual non-responders followed by a monthly search to increase the earlier detection of colorectal cancer.
The project will raise awareness and improve the uptake of bowel cancer screening, working with local volunteers, targeting low uptake areas/practices linked to deprivation and BME groups.
The project will raise awareness and improve the uptake of bowel cancer screening by working in collaboration with all GP practices, the local council, public health and cancer educators.
The project aims to reduce the inequality in uptake of bowel cancer screening, initially working with those areas and GP practices with below average uptake. Evidential learning from bowel cancer will be shared across other clinical areas as appropriate.
Through the improvement of systems, processes and IT solutions in primary care, the project aims to increase public awareness of cancer in high risk groups through community engagement, reduce delays in referral and diagnosis and increase uptake of bowel screening.
This is a pilot study exploring primary care involvement in re-engaging patients with the National Bowel Cancer Screening Programme who have previously tested positive on screening but failed to complete colonoscopy.
The project aims to use targeted support for GPs to code non-responders to the National Bowel Screening Programme, contacting patients to raise awareness and improve uptake. Non-clinical cancer champions will be the main point of contact for patients, following training and support.
Merton CCG is looking to develop a GP endorsement campaign for bowel cancer screening through pre-invitation and follow up for non-responders to improve uptake and raise awareness.
The project aims to use healthy living pharmacies and cancer champions to raise awareness of lung and bowel cancer, including encouraging bowel screening uptake.
The project aims to increase the number of people taking part in the bowel screening programme through direct personalised communication from GP practices.
Project members aim to improve the uptake of national bowel cancer screening programmes through personalised communication from GP practices direct to patients.Close
The projects in this cluster aim to streamline diagnostic pathways for colorectal cancer. Some projects do this via straight to test approaches such as GP direct access to endoscopy, others undertake triaged access to diagnostics.
It is hoped this cluster will identify the 'best first test' and 'best test mix' for diagnosing colorectal cancer as well as comparing straight to test and triaged approaches.
The project will evaluate the impact of a number of interventions and pathway enhancements to improve the timely diagnosis and experience for urgently referred patients with oesophageal and gastric cancers.
Project members will aim to reduce patient waiting time from referral to investigation and diagnosis of colorectal cancer by implementing STT flexi sig for appropriate 2WW referrals.
A quality improvement collaborative has been established to implement STT models of care across member organisations of London Cancer. These models will offer a faster pathway for patients, an effective diagnostic service for GPs and an efficient pathway for Trusts to increase earlier diagnosis of colorectal cancers.
The project aims to provide GPs with a direct access diagnostic service for the referral of patients who have concerning lower GI symptoms, but who do not fit the 2WR criteria, primarily because of age.
The project aims to develop an integrated model of care between primary and secondary care, avoiding duplication of clinical consultation, shorten time to diagnosis and MDT discussion, and reduce delays to treatment with no additional investment.
The project is evaluating the existing direct access diagnostic endoscopy service provided by In Health for patients that do not fulfil the 2WW criteria. The service will be evaluated against the service provided by Peterborough Hospital.
The University Trust aims to reduce waiting time from 2WW urgent GP referral to investigation and diagnosis of patients referred with colorectal cancer symptoms.
The project will develop a STT service for 2WW suspected colorectal cancer referrals that will enable patients to be booked directly to endoscopy following triage for their diagnostic procedure, reducing waiting times to a maximum of 14 days.
The project will provide a ‘one-stop, GP direct access service’ for the diagnosis of rectal bleeding and other high risk symptoms to promote the earlier detection of bowel cancer.
The project will evaluate the impact of STT approaches for patients with colorectal symptoms in order to develop a sustainable pathway. The project will also test the merging of referral routes to ensure both urgent and routine referrals are simultaneously fast tracked through the diagnostic process to timely treatment.
In order to streamline the earlier diagnosis of colorectal cancers and ensure faster treatment, the project will pilot a STT electronic pathway that focuses on 2WW and routine referrals based on symptom criteria.
This project will implement a STT diagnostic colonoscopy service for patients referred via the 2WW pathway with colorectal cancer symptoms. The project will exclude patients under 40 and over 75 years of age – these patients would attend regular our patient clinics.
The projects in this cluster seek to embed use of the Macmillan electronic Cancer Decision Support (eCDS) tool in general practice to identify high risk patients and improve the appropriateness of cancer referrals.
It is hoped that this cluster will evaluate the impact of using the eCDS tool in general practice and identify how best to encourage and support GPs to incorporate the eCDS into their daily practice.
Prospective audit of cancer diagnoses using the eCDS tool in a General Practice with 125 GPs.
Development of template to record GP action following consultations using Macmillan eCDS tool to compare resulting cancer diagnoses with historic data/data from practices not using eCDS to ascertain impact on conversion rate of two week wait referrals and stage of diagnosis.
Testing the use of Macmillan eCDS tool risk stratification function to identify patients at high risk of cancer within a General Practice in Gateshead and then proactively inviting those patients to visit the GP where advice, referral or diagnostic tests may be offered as appropriate.Close
The projects in this cluster are focused on streamlining lung cancer diagnostic pathways through the introduction of direct access to rapid diagnostics, with many projects seeking to implement 'straight to CT' pathways, i.e. diagnostic pathways which undertake a CT scan on a patient after a first unclear chest x-ray.
It is hoped that the cluster will identify the best way to integrate CT into the lung cancer diagnostic pathway and what is the best first test for lung cancer.
The project will develop a new pathway for cancer patients going to Brighton and Sussex University Teaching Hospitals (BSUH), which will involve going straight to CT following an abnormal chest x-ray.
Through direct access to CT by GPs, when locally agreed criteria have been met, the project aims to improve 2WW pathway flow and appropriateness of straight to test and one-stop clinics referrals.
Transforming Outcomes and Health Economics Through Imaging (TOHETI) project aims to facilitate direct access to imaging services from primary care, streamline diagnostic pathways and improve patient experience.
The projects will complete an audit to review and establish key reasons for delay in presentation with lung cancer as well as develop and implement an integrated and streamlined lung pathway.
The above projects will work together to standardise and streamline their lung cancer pathway in the Essex region.
The project will perform a data analysis to drive improvement of sectorised model of care, measurement and performance management and define quality standards of lung cancer pathways in Manchester.
To introduce a system by which an abnormal chest x-ray automatically triggers a CT scan request by radiologist, GP informed and eGFR requested – to reduce the anxiety of non-cancer patients and improve diagnostic investigation time for cancer patients.
By developing a straight to CT following an abnormal chest x-ray pathway, the project has many aims including; promoting joined-up working between primary and secondary care and improving lung cancer survival rates through earlier detection.
The projects in this cluster use non-GP primary healthcare professionals such as community pharmacists and optometrists to play a role in early diagnosis of cancer through awareness raising and direct referral to secondary care or diagnostics.
It is hoped that this cluster will identify how best non GP primary healthcare professionals can be utilised to contribute to early diagnosis of cancer including the effectiveness of direct referrals and patient engagement methods.
Cancer awareness raising activities through community pharmacies and community pharmacist direct referral to chest x-ray pilot.
By using healthy living pharmacies and cancer champions, the project aims to raise awareness of lung and bowel cancer including encouraging bowel screening uptake.
South Tees Optometrist Referral Project (STORP) project aims to pilot direct referral to neuroscience from optometrists in Middlesbrough for people with field vision defects.
The first interim report of this cluster, which is on direct referral is now available: Direct referral of suspected cancer patients by non GP primary care health professionals [PDF].
The second interim report of this cluster, which looks at pharmacy training is now available: Pharmacy training for early diagnosis of cancer [PDF].Close
The projects in this cluster are developing interventions to identify symptomatic patients who may be at high risk of lung cancer. One project includes a small pilot of patient self referral to chest x-ray.
It is hoped this cluster will identify the best ways to find people at high risk of lung cancer as well as assess the effectiveness of interventions offered to high risk people.
The project aims to achieve a step change improvement in earlier diagnosis by utilising a risk-stratification process to identify people at highest risk of lung cancer; and then offering them a low dose CT scan as well as targeted smoking cessation advice and support.
The project will raise awareness of respiratory health and illness in communities with high incidence of lung disease and lung cancer. Members of the project will also work with GP practices to risk assess people, and offer low dose CT to those who meet agreed criteria.
The project is focusing on health prevention and promotion of healthy lungs as well as the introduction of a self-request chest x-ray service targeted at populations where incidence and mortality is high.Close
The projects in this cluster seek to use opportunistic and community outreach approaches to encourage screening uptake in vulnerable groups such as people with learning disabilities and some ethnic minority groups. Projects use a mixture of GP outreach activity and community outreach in collaboration with voluntary sector organisations.
It is hoped that this cluster will identify best practice approaches to increasing screening uptake in vulnerable groups.
The Voluntary, Community and Faith Sector will take a proactive, community based approach to improving diagnosis by engaging with vulnerable groups to raise awareness of screenings and achieve a more efficient pathway and timely diagnosis.
The project will look at whether personal contact from GP practices, to those patients who have failed to attend their third cervical smear invite, will improve uptake.
The key aim is to reduce inequality for people with a learning disability accessing the national cancer screening programmes. (Breast cancer screening, bowel cancer screening and cervical cancer screening.)
The project seeks to improve participation in the NCSP across Cumbria, particularly in more vulnerable population groups, by increasing and adapting invitation and follow-up communications using text messaging.
To raise awareness and improve the uptake of cervical screening in Middlesbrough, through direct personalised communication from GP practices.
All practices will be required to plan and implement changes that have the potential of increasing uptake of all cancer screening in their patients with learning disabilities.
The project aims to improve cancer screening uptake in the South Asian community in North Kirklees. Project members plan to raise awareness with the local community groups, communicate findings to GPs and work with practices to improve myth busting with communities.Close
The projects in this cluster seek to implement diagnostic pathways for patients with vague but concerning symptoms, which may be indicative of cancer, but do not have an obvious possible tumour site. Projects include the establishment of Cancer of Unknown Primary/Malignancy of Unknown Origin pathways, acute oncology services and one project establishing a Multidisciplinary Diagnostic Centre (MDC).
It is hoped this cluster will identify the most efficient diagnostic pathways for patients with vague but concerning symptoms that may be cancer.
The aim of this project is to develop a pathway for patients with vague symptoms within the named Strategic Clinical Networks (SCNs).
This acute oncology project which sets out to 1) provide a more efficient pathway for urgent referrals where there is evidence of cancer but no signs/symptoms to suggest the location of the primary cancer (CUP) and 2) develop a service for dealing with patients with vague symptoms where cancer may be a diagnosis amongst other serious diseases.
The project aims to establish a primary investigation clinic for those suspected (for any reason) of a diagnosis of a cancer where the primary tumour site is unknown.
The project incorporates a Multidisciplinary Diagnostic Clinic (MDC) pilot aims to provide a timely diagnostic pathway for patients with abdominal pain, weight loss or painless jaundice, to improve patient flow and reduce unnecessary admissions for patients with these symptoms.
ROCkeTS is a diagnostic test accuracy study that aims to identify, refine and validate tests and clinical risk scores (risk prediction models) that estimate the probability of having ovarian cancer in post and premenopausal women with symptoms.
The project aims to establish a new electronic referral system from GPs to radiology in order to get triage advice on the most suitable imaging for a patient with suspected cancer who presents with vague symptoms.
This Acute Diagnostic Oncology Clinic (ADOC), will set up and evaluate a five day direct access service for GPs to refer patients who 1) meet the criteria for a 2ww referral but are unable clinically to wait for the two week referral pathway, or 2) where the GP suspects the patient has cancer but does not know to which site specific team the patient should be referred.
The project includes a full CT for suspicious symptoms (CUP) to estimate incidence of suspected MUO cases that are not captured by existing 2WW, test use of CT CAP for this population.
The Manchester Cancer Jaundice Pathway project will provide earlier diagnosis and timely referral for patients with pancreatic cancer through same-day definitive radiological imaging and fast-track referral for early surgery.
East and West Suffolk CCGs and Hospital Trusts have put in place a simple pathway project to help manage patients with unexplained weight loss.
Through retrospective study, the project aims to develop and evaluate a vague symptom referral/risk assessment criteria and a vague symptom diagnostic pathway.Close
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