Improving early cancer detection with C the Signs

22nd December 2021

About C the Signs

C the Signs was founded in 2017 by two NHS doctors after losing a patient to late-stage cancer.

C the Signs is an evidence-based AI system (integrated with EMIS, SystmOne and Vision) that supports healthcare professionals to identify the earliest signs of cancer and fast track patients to the most appropriate direct-access diagnostic or two-week-wait cancer referral – all in under 30 seconds.

You can find out more by watching this short video:


C the Signs 2021 Impact Data

Cancer risk assessment & primary care triage

  • 100% adherent to NICE Cancer guidelines & configured locally to cancer & pandemic pathways
  • < 30 seconds to risk assess & refer patients – identifying which cancer(s) a patient is at risk of & what test or referral is needed
  • Reassure GPs & patients where patients are not at risk of cancer, and do not need an urgent referral
  • Linked patient information leaflets and resources to text/email to patient


Smart referrals

  • 100% of referrals are clinically appropriate
  • Forms are customised and standardised across all hospital & community providers
  • Prevents inappropriate referrals being sent
  • Customised mandatory fields, pre-populated with critical information (including prehab, pre-op, performance status etc).
  • Switches between providers to refer to appropriate service
  • Changes to criteria or forms made in 48 hours & updated centrally

Safety-Netting & tracking Patients with Suspected Cancers

  • 100% of patients automatically safety-netted onto a practice dashboard, whether on a referral or diagnostic pathway
  • Real-time of view of all patients on a suspected cancer pathway
  • Results are pulled through from medical records automatically
  • Alerts to flag when patients have been waiting beyond national time frames


Cancer Dashboard

  • Real-time view of all patients with a cancer diagnosis
  • Track time from referral to diagnosis
  • 3- and 12-month cancer care reviews
  • Patient emailed/SMS PDF of review – all cancer care information in one place


Real-time Performance Dashboard- Practice & PCN

  • Real-time view of cancer data: referrals, diagnostics & new cancers diagnosed
  • track cancer conversion rates by tumour type and pathway
  • Data to support demand & capacity, and identify inequalities & delays
  • Identify practices & PCNs requiring additional support to improve performance

C the Signs demo in EMIS, SystmOne and Vision

C the Signs Pilot Sites 2018/2019

  • Cancer detection increases when C the Signs is commissioned
  • Referral rates remain stable (so increased detection is NOT as a consequence of increased secondary care activity

York Health Economic Consortium Evaluation East of England 2018

  • C the Signs had a statistically significant impact on cancer detection rates compared with the rest of East of England and matched controls
  • The rate of cancer detection in primary care in the trial CCGs improved significantly compared to the rest of the region, this is likely to represent diagnostic stage shift in the trial CCGs.

Evaluations during the pandemic 2021

  • Despite a pandemic year C the Signs has been able to detect MORE patients with cancer at LOWER referral rates
  • C the Signs detected 8% more cancers with 5% fewer 2 weeks wait cancer referrals. This reduction in 2 week wait referrals equates to a cost saving of £75,348, and a saving of 27 days of consultant run clinic time.

Information Governance & Security

  • MHRA Class 1 Medical Device with CE marking
  • NHS Digital Data Security and Protection Toolkit compliant
  • NHSx Digital Technology Assessment Criteria for health and social care (DTAC) compliant
  • Cyber Essentials Plus Certified
  • ISO 20000-1 Certified
  • HSCN approved user
  • NHS Digital DCB0129 Clinical Risk Management Standard compliant
  • General Data Protection Regulation (GDPR) and Data Protection Act 2018 compliant
  • Registered with the Information Commissioners Office (ICO), compliant with ICO Data Analytics toolkit and Anonymisation code of practice
  • Integrated with Primary Care Electronic Health Record Systems: EMIS, SystmOne, and Vision through the NHS Digital IM1 Programme
  • All information is coded in SNOMED CT codes back into the patient’s records
  • NHSx Digital Playbook for Cancer


Supporting National Cancer Targets

Primary Care targets – C the Signs has been recommended in National Cancer Policy Papers by NHS England and NHS Improvement and can help achieve the following:

  • PCN Direct Enhanced Services for early cancer detection
  • Primary Care Quality Outcome Framework for early cancer detection
  • Primary Care Quality Improvement Module

Secondary care cancer targets – C the Signs can support with achieving the following targets and report on the following:

  • 14 day waiting time standard
  • 28-day diagnostic standard implementation of rapid diagnostic clinics and STT pathways
  • 62 day treatment time standards

C the Signs can support achieving the NHS Long Term Plan objectives:

  • 75% cancer detection rate 2028
  • Faster diagnostic standards
  • 55,000 cancers diagnosed earlier


New features coming in 2022

  • eRS integration – supporting healthcare professionals to book 2-week-wait appointments within the consultation in a couple of clicks
  • C the Signs Case Finding Tool for missed patients with cancers – allowing practices to rapidly screen their entire patient population for anyone with symptoms of cancer who should have been referred
  • C-Screen Cancer Screening Dashboard – automating cervical screening and recall for patients within a practice and providing patients with appropriate information to support uptake of the screening programmes
  • Stratified Follow-up Dashboards – safety-netting patients who may have cancer (e.g. prostate cancer, low grade lymphoma) or a predisposing condition (e.g. MGUS or a nodule) so they can be tracked and are not lost to follow-up



  • Somerset Clinical Commissioning Group
  • South Yorkshire and Bassetlaw Cancer Alliance
  • South Yorkshire and Bassetlaw Integrated Care System
  • Oxfordshire CCG
  • North East London Cancer Alliance
  • North East London Clinical Commissioning Group
  • North West London Clinical Commissioning Group
  • South East London Cancer Alliance
  • South East London Clinical Commissioning Group
  • Ipswich and East Suffolk Clinical Commissioning Group

C the Signs is currently being used by over 7,000 healthcare professionals across 1,000 GP practices.


Contact info

For further information or to book a demo of the system please email us a