A Clinical Audit on 2WW Cancer Referrals:-

A comparison of 6-monthly data from 2019 vs 2020.

(Farnham Road Practice)

By Dr Mohammed Anwar,
GPST2, Windsor Deanery VTS

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 Aims & Objectives
• Identify FRD referral patterns across different specialties
during 2019 and COVID-19 era.
• Understand which local outpatient speciality clinics are most
efficient in meeting the 2WW criteria.
• How successful are we in detecting potentially benign vs
malignant cancer?
• Discuss learning points and potential changes in clinical
practice.

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 Background
National 2WW targets implemented in 2000.
National 2WW compliance rate is 93%.

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Data Collection:-
(a) April 2019 – Sept 2019
(b) April 2020 – Sept 2020

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 EMIS Search Criteria for FRD patients
(April 2019 – September 2019)

5 patients
excluded due
Initial Search Criteria: - 409 referrals to leaving
practice or
deceased.

Final Search Criteria: - 404 referrals

N = 394 patients

Single Two >Two

Referral Referrals Referrals

379 patients 15 patients 0 patients 5

 EMIS Search Criteria for FRD patients
(April 2020 – September 2020)

16 patients
excluded due
Initial Search Criteria: - 396 referrals to leaving
practice or
deceased.

Final Search Criteria: - 380 referrals

N = 352 patients

Single Two >Two

Referral Referrals Referrals

329 patients 20 patients 3 patients 6

 Patient Demographics
• There are proportionately more female 2WW cancer referrals compared
with male patients.

• There is an average 13-year age gap between men and women.

• Why is there this age gap between men and women when it comes to
2WW cancer referrals?

• Are FRD cancer referrals going in the right direction in terms of early
detection of cancer in 2020?
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List of 2WW Cancer Referrals
• Breast
• Dermatology
• ENT (Head and Neck)
• Gynaecology
• Haematology
• Lower GI/Colorectal
• Upper GI
• Neurology (Brain & CNS)
• Respiratory
• Sarcoma
• Urology 8
Five- Part Analysis of Results

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What were the most popular specialties
for 2WW referral?

Part 1

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 April 2020 - Sept 2020
Comparison of Referral Trends from 2019 vs 2020 April 2019 - Sept 2019

Breast
Lower GI
Derm
Upper GI
Gynae
Urology
ENT
Brain
Resp
Haem
Sarcoma

0 20 40 60 80 100 120

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A Comparison of FRD Monthly Referral
Trends
(April –Sept 2019 vs April – Sept 2020)

Part 2

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 Monthly Referral Trends across 2019 vs 2020 Data
100

90

80

April 2019 - Sept 2019

70
April 2020 - Sept 2020

60

50

40

30

20

10

0
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Our Local 2WW Hospital Targets and
monthly trend (April-Sept 2020)

Part 3

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 Year 2019
Compliance of Hospital Specialties in seeing patients in <2 weeks from referral Year 2020

100%
100%

90%

80% 79%
73%
70%
70% 68%

60% 58% 59%

56%
53%
50%

40%
33%
30%

20%

10%

0%
0%
Haematology Respiratory Gynaecology Neurology Upper GI Urology Dermatology Lower GI Breast Head and Neck Sarcoma

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 Overall Moving Average of Patients seen <2 weeks across all outpatient specialties
100%

95%

90%

85%

80%

75% Year 2019

Year 2020

70%

65%

60%

55%

50%
April May June July August September
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 FRD Cancer Detection Rates
(April – Sept 2019 vs April – Sept 2020)

Part 4

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FRD Cancer Detection Rates (2019 vs 2020 Data)

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 How did we perform against National
UK data?
National UK data for 2WW GP Referrals
• From 2018/19 period, there were over 2.3 million referrals.
• Cancer pick-up rate was 6.6% in UK.

FRD 2WW GP Referrals (April 2019- September 2019)

• 404 referrals
• 17 referrals excluded
(i.e. loss to follow-up, DNA or ongoing hospital investigations)

Final Adjusted Calculation = 17/387 = 4.4% pick-up rate.

FRD 2WW GP Referrals (April 2020- September 2020)

• 380 referrals
• 15 referrals excluded
(i.e. loss to follow-up, DNA or ongoing hospital investigations)
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Final Adjusted Calculation = 24/365 = 6.6% pick-up rate.
FRD Individual Referral Data for period
of April – Sept 2020
(Anonymised)

Part 5

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Table 4.1 – Breakdown of FRD Referral Numbers from April 2020 – September 2020

Range of 2WW Frequency Cumulative Total

Referrals
1–5 18 18
6 – 10 7 25
11 – 15 5 30
16 – 20 5 35
21 – 30 2 37
30 + 1 38

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 Frequency of 2WW Cancer Referrals amongst FRD Clinicians
(April 2020 - September 2020)
90
82
80

70

60

50

40

30
30 27

20
20 17 17 17 18
15 15
13 14
9 10 11
10 6 6 6 6 7
4 5
2 2 2 2 2 2 2 3
1 1 1 1 1 1 1 1
0
r r r r r
ra o. 5 . 12 . 13 . 16 . 21 . 24 . 26 tra iate iate o. 4 . 22 . 25 . 27 o. 8 o. 9 . 20 ctor iate o. 7 . 18 . 19 . 15 o. 2 . 23 . 14 . 11 o. 3 o. 6 tra o. 1 . 10 . 17 GP tra tra G P
st N No No No No No No g is oc oc N No No No N N No o oc N No No No N No No No N N gis N No No ew gis gis ew
gi
Re GP GP GP GP GP GP GP Re Ass Ass GP GP GP GP GP GP GP F 2 D Ass GP GP GP GP GP GP GP GP G P GP Re GP GP G P r/N Re Re r/N
GP GP cian cian an GP ra GP GP tra
s i si s ici g is t gi
s
y y y Re Re
Ph Ph Ph
GP GP

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 Conclusive Findings
• Top 3 specialties by FRD = Breast, Lower GI and Derm.
• c 2WW average compliance across hospital specialties =
60% (2019) vs 66% (2020).
• FRD Cancer Detection Rate = 4.4% (2019) vs 6.6% (2020).
• c age difference (male vs female) = 13 year difference.
• In 2020, referrals were made at an earlier age for male and
female.
• According to 2010/11 study, the average GP put in 20-25
referrals per year (10-13 referrals/year).
• Whilst most clinicians from FRD were referring an average
number of 9-10 referrals during 6-month period in 2020, there
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was an odd outlier.
 Learning Points
• We need to be aware of the important red-flags associated
with 2WW cancer referrals.
• Ensure to stratify risk of cancer based on presenting red flags,
risk factors such as smoking and ETOH intake, medical Hx and
FHx.
• Familiarisation of DXS referral forms.
• Investigate as appropriate within the primary care setting
before considering a 2WW referral – there may be other
differentials that can be excluded!
• Use of ‘Advice and Guidance’ for secondary care opinion vs
Informal WhatsApp groups.
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Thankyou for listening!

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