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
- Consistently evaluates best practice and innovative approaches to early diagnosis of cancer.
The overall objective of ACE is to develop a body of evidence on different approaches to early diagnosis of cancer in order to inform future commissioning of cancer services. ACE has two key aims; first to help NHS organisations implement best practice including identifying and tackling system blocks, and second to test more innovative ideas such as streamlining current pathways and developing new pathways for vague but concerning symptoms.
ACE seeks to drive:
- A shift from late to early diagnosis of cancer at Stages I & II
- A decrease in cancer diagnoses via emergency presentations
- Improvements in overall patient experience
You can also learn about the structure and organisation of ACE and the ACE thematic clusters.
For an overview of the ACE programme please download this PDF.
The ACE programme pharmacy/primary care cluster is pleased to release two interim reports, the first on direct referral of suspected cancer patients by non GP primary care health professionals and the second on training of pharmacy staff for early diagnosis of cancer.
Variations in performance and practice
The lung cancer pathways interim report provides an opportunity to share some of the information gathered so far and to introduce the next phases of the process. There are six ACE projects within the Lung Pathway cluster, testing a range of different pathways and/or pathway elements as well as communication methods and motivation techniques. The majority of projects are trying to achieve better/faster access to CT.
The ACE Lung programme aims to help commissioners and providers to meet these standards by providing evidence of the impact of implementing particular changes, and by providing relevant information and tools that can be used to improve local services.
A more detailed analysis and evaluation of these six projects will be undertaken by the ACE programme in summer 2016.
Setting up direct referral for early diagnosis of cancer
The first report presents two ACE direct referral projects, one involving community pharmacists and the other involving optometrists. The community pharmacy project is a direct referral to chest x-ray for people with suspected lung cancer being piloted by Doncaster CCG. The optometrist project is a direct referral to neuroscience for people with field vision defects being piloted by South Tees NHS Foundation Trust.
The aim of both projects is to identify and refer patients more quickly in order to improve early diagnosis of cancer and other conditions, and thus improve patient outcomes.
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.
Both projects are currently underway and a more detailed analysis of their impact will be undertaken by the ACE programme during 2016.
Appropriate training helps pharmacies play a role in early diagnosis of cancer
Appropriate training of community pharmacy staff can enable them to play an important role in getting cancers diagnosed earlier, ACE recommends in its second interim report.
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.
England lags behind comparable European countries when it comes to cancer outcomes including 1 and 5 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.
ACE was established following an early diagnosis of cancer summit on 4 June 2014 convened by NHS England and held at the Royal College of General Practitioners in London. The summit was attended by a variety of stakeholders including leading clinicians, Public Health England, Clinical Commissioning Groups, Medical Royal Colleges, Macmillan and Cancer Research UK.
The ACE programme issued a call for projects in June 2014 with a deadline to respond of 31 July 2014. NHS England, Macmillan and Cancer Research UK all disseminated the call as widely as possible. The call asked for projects addressing the following areas:
- Straight to test & one stop clinics
- Merging of referral routes – urgent and standard pathways
- Multidisciplinary diagnostic centres (MDC or ‘Danish model’)
- Self-referral for diagnostic tests
- Pro-active approaches to high risk patients
- Improving screening uptake generally and/or specifically in vulnerable adults
- Use of IT in primary care to identify and/or flag high risk patients
- Pathways for patients with vague symptoms
- Lowering the thresholds for two week wait referrals
- Greater role for pharmacists, opticians and other healthcare professionals in cancer referrals
Many NHS organisations across England submitted applications to have their projects included in the ACE programme. In total 89 expressions of interest (EOIs) were received and 60 projects were initially accepted into the ACE programme. The projects accepted into the ACE programme were grouped thematically into eight clusters as follows:
Download a full list of ACE projects organised by thematic cluster here [PDF].
For more information on the ACE programme, please email ACE@macmillan.org.uk, or telephone 020 7840 3579.