Record numbers of people in the North West are being checked for cancer, with more people being diagnosed at earlier stages than ever before.

As of August 2022, 382,956 people registered with GPs in the North West were seen by providers following an urgent GP referral for suspected cancer*. By contrast, between March 2019 and February 2020 (prior to the pandemic), fewer than 309,956 people were seen by providers following an urgent GP referral for suspected cancer in the region.

Over the last 18 months, NHS staff have been working hard to recover the shortfall in cancer referrals, and thanks to extensive NHS campaigns and early diagnosis drives more people are coming forward than ever before.

Dr Michael Gregory, Medical Director for NHS England in the North West, said: “The NHS across the North West continues to work tirelessly to address the waiting lists that have grown and been exacerbated throughout the COVID-19 pandemic and to ensure that our most vulnerable patients, and those waiting the longest, are treated and cared for as quickly and as efficiently as possible.

“In recent months the NHS has seen extraordinary high demand for its services, including people referred by their GPs for suspected cancer, and I’d like to thank our NHS staff who are working extremely hard to provide timely treatment to those who need it most, and to catch cancers earlier than ever before.”

Dr Gregory added: “We understand how difficult it can be for patients to wait longer than expected to receive treatment after a GP referral and strongly encourage anyone concerned about new or worrying symptoms** not to delay contacting their GP and getting checked to ensure they can be seen as soon as possible.”

Across the region NHS staff continue to establish important initiatives and are taking significant measures to ensure local people receive the treatment they need, including, but not limited to:

In Greater Manchester:

• A new, One Stop Lung Cancer Clinic, at Wythenshawe Hospital in partnership between the Greater Manchester Cancer Alliance, Manchester University NHS Foundation Trust and The Christie NHS Foundation Trust for patients diagnosed with lung cancer suitable for curative intent treatment with either surgery or radiotherapy, when it is not clear which the best option is. The clinic which launched in June this year has already demonstrated reductions in the time taken for a decision to be made regarding patient treatment, enabling patients to start their treatment sooner, with data showing the time from referral for treatment to a decision being made has reduced from an average of 35 days to 7 days as a result of this clinic model, for this cohort of patients.
• The continued roll-out of Rapid Diagnostic Centres across Greater Manchester, building on the three locations already operating across the area. These clinics involve rapid assessment for patients with vague symptoms such as weight loss, fatigue and pain that could indicate a number of different cancers. Patients are seen and tested and then referred into the correct cancer pathway if necessary, reducing length of time to be diagnosed.
• Ongoing work led by NHS Greater Manchester Integrated Care to strengthen joint working across Greater Manchester and our ability to use mutual aid to reduce waiting times.

In Lancashire and South Cumbria:

• Continued roll out of the innovative Cytosponge, or ‘sponge on a string’ to help identify people most at risk of oesophageal (gullet) cancer and be available close to people’s homes is set to improve cancer care and ease the pressure on health services in Lancashire and South Cumbria. The Cytosponge is now live in all three localities across L&SC and running well, with positive feedback from both patients and staff involved in the pilot. Due to the success of this pilot, the service is being extended in all three localities until March 2023.
• In conjunction with a range of stakeholders, Lancashire and South Cumbria ICB, is undertaking a comprehensive mapping exercise, to deliver a clear, effective and inclusive review of the current service provision from presentation at GP, to referral, to first appointment/triage to understand the challenges and ‘pinch points’ in the system. This will enable the cancer alliance to establish and implement an enhanced front-end service provision and pathway which meets the needs of NHS partners with patients at the heart.
• The Cancer Alliance is also in the process of scoping a whole system digital solution to support a fully integrated Teledermoscopy service across Lancashire and South Cumbria.
• Pathway improvement work continues in upper gastrointestinal series (UGI) cancers at each of the four acute Lancashire and South Cumbria trusts with a focus on improving timely clinical triage, Straight to Test (STT) processes to endoscopy, workforce etc.
• There has been a change in the sarcoma pathway this year, and now all GPs across the Lancashire and South Cumbria Cancer Alliance have access to Direct Access US for Suspected Soft-tissue Sarcoma. GPs are asked to request a DA US initially; upon receiving the DA US report if a Sarcoma is suspected, the Trust will advise that the patient be referred to the specialist Sarcoma diagnostic centre at Lancashire Teaching Hospitals. There is also a dedicated referral form for suspected Lipoma.
• Non-specific Symptoms – All four acute trusts in Lancashire and South Cumbria have an established NSS pathway with forms available on EMIS/PRIMIS referral systems to access – this is available to 100% of GPs across Lancashire and South Cumbria Cancer Alliance. GPs are asked to ensure that a full suite of filter function tests (>12 tests) be ordered and reviewed before referral to the NSS pathway. The suite of tests can be ordered as a bundle on pathology systems. Providing the full suite of tests gives the patient the best chance of proceeding to the right diagnostic quickly.
• A new course is available on Gateway C to support GPs with clinical decision making with regards to non-specific symptom (NSS) pathways which aims to support clinical decision making with regards to non-specific symptom (NSS) pathways.

In Cheshire and Merseyside:

• The Transnasal Gastroscopy service at Broadgreen Hospital in Liverpool is reducing waiting time for patients who need further diagnosis. The procedure involves a tube and camera which goes up the nose instead of down the throat, to the area that needs to be studied. The patients are in less discomfort, which leads to faster recovery times. Because patients do not need to be slightly sedated during this form of endoscopy, TNG has been shown to be quicker, safer have lower costs and means more patients can be seen during a session.
• An accelerated training scheme in Cheshire and Merseyside to tackle the endoscopy backlog by enabling additional supervised training to enable endoscopy trainees nearing provisional sign-off to get that sign off sooner – so far 15 endoscopists have completed their training, providing additional capacity.
• Further roll out of Cytosponge or ‘sponge on a string’ to help identify people most at risk of oesophageal (gullet) cancer and be available close to people’s homes is set to improve cancer care and ease the pressure on health services, after a successful pilot at Countess of Chester and St Helens and Knowsley.
• Another initiative has seen 49,000 patients undergo a faecal immunochemical test (FIT) as an alternative to endoscopic procedures. The use of FIT in this way is providing a faster turn-around of results. Patients provide samples at home rather than attend hospital, making it more convenient for them. 67% of patients undergoing the FIT procedure needed no further secondary care treatment as a result of the test, which means that endoscopy capacity is saved for those who have a greater clinical need.
• Across Cheshire and Merseyside Community Diagnostic Centres have opened to give quicker diagnoses to patients, usually much nearer to home. Several have opened across the area in the past year with more to follow.