Colorectal Best Timed Pathway

Colorectal cancer is the fourth most common cancer and the cancer that takes the second highest numbers of lives every year in the UK. Greater Manchester is currently facing challenges with the delivery of the cancer waiting time standard for colorectal cancer, with 67.5% of patients receiving their treatment within 62 days for 2018/19. (national standard 85%). Furthermore, by 2020 the new Faster Diagnosis Standard of confirmation of cancer diagnosis (or no cancer) by day 28 following a suspected cancer referral will be implemented. Meanwhile the number of colorectal urgent referrals continues to increase significantly year on year.

This project is solely focused on the first 28 days of the pathway. It aims to support Trusts to establish or improve upon straight to test (STT) for appropriate patients and first clinic appointment within 7 days for those not appropriate for STT, reducing the time to a diagnosis and ultimately treatment.

Transformation Funding will cover the costs of Band 7 Clinical Nurse Specialists (CNS) to lead triage processes and Band 4 Cancer Navigator roles to support patients and streamline the pathway. It is anticipated that this investment will be more than balanced out by the savings associated in the reduction in Outpatient Appointments and reductions in DNAs / cancellations for endoscopy associated with the project. The project aims to ensure that whatever area a patient is from, they experience the same level of care and have the same chance of receiving a definitive yes/no cancer diagnosis no longer than 28 days after urgent referral.

Aims and objectives of service

1) Achieve Faster Diagnosis Standard (28d) by March 2020 (*While not yet widely released, we anticipate the FDS National Standard to be set at 77%), including associated outcomes that sit under this as displayed in the Outcome Measures Framework

2) Reduce to <50% the percentage of patients who require an OPA before endoscopy, releasing OPA capacity

3) Reduce the number of DNAs and cancellations for first investigation by 30%

4) Decrease by 30% the number of occasions that secondary care needs to contact primary care in relation to a urgent colorectal cancer referral i.e. needing more information that was not included in the original referral.

5) More than 90% of suspected colorectal cancer patients rating their diagnostic pathway as good/very good/excellent by end March 2021 (scale for patient experience survey to be confirmed)

If this project succeeds we would expect:

Patients: To receive faster diagnosis; improved associated outcomes; less unnecessary outpatient appointments and  report higher comparative levels of patient satisfaction on the new pathways

Secondary care health professionals: To see improved outcomes for patients; report their own time being used more efficiently and effectively; in some cases have tasks being taken off their hands to enable more direct contact with patients; to be positively impacted by the resource savings associated with decreasing the number of out patient appointments

Primary care health professionals: To see improved outcomes for patients; to feel more confident about their urgent referral process for colorectal cancer; to have a stronger relationship with secondary care in relation to their colorectal pathway

Commissioners: To observe improved outcomes for patients; to feel confident of their locality meeting the 28 day standard from April 2020; to observe improvements in the 62 day standard


Jonny Hirst
Project Lead
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David Smith
Clinical Lead
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