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C the Signs impact across NHS sites

C the Signs takes an evidence driven approach to improving cancer outcomes. The system has undergone independent evaluations and validation with each NHS partnership. C the Signs has helped Clinical Commissioning Groups and Integrated Care Systems across the NHS increase cancer detection rates, improve the speed of diagnosis and ensure the appropriate use of resources.

To learn more about the C the Signs system, please use the links below.

Impact by area

South Yorkshire and Bassetlaw

National waiting times

The pandemic led to a significant deterioration in the 14-day and 62-day time standards across England, including in South Yorkshire and Bassetlaw (SYB). This led to delays to diagnosis and treatment start time for patients.

SYB Cancer Alliance commissioned and deployed C the Signs during the pandemic. The graph below illustrates the impact C the Signs had on the national waiting and treatment time standards.

The graphs demonstrate that following implementation of C the Signs, the 14-day and 62-day time standards recovered in SYB and continued to be protected from the ongoing impact of the pandemic. This was unlike the impact seen across England, where performance of the 14 and 62 day standard continued to decline.

Qualitative feedback

“The best system. Easy to use, links in with whatever system you use and is updated on a regular basis.”

Cancer Care Coordinator, SYB

“Great – love using the symptom checker when unsure where to go next with vague symptoms.”

General Practitioner, SYB

“Helpful and easy to complete 2ww forms and to keep track of cancer referrals and their pathways.”

Medical Secretary, SYB

Oxfordshire

Cancer detection and referral rates

GP practices in Oxfordshire trialling C the Signs saw an improvement in their cancer detection rates during the pandemic (64% versus 61.2% pre- pandemic), despite a drop in the number of cancer referrals made. In comparison, the control group of GP practices in Oxfordshire not using C the Signs saw a significant drop in their cancer detection rates during the same timeframe, despite the control practice having a higher baseline cancer detection rate.

Though there was a reduction in referral numbers across both sites during the pandemic, the percentage drop was smaller in the C the Signs trial practices (-13% versus -17%), suggesting the system provided a protective effect on referral numbers.

East of England

Cancer detection and referral rates

An evaluation conducted by York Health Economics Consortium (YHEC) looked at the impact of C the Signs across three Clinical Commissioning Groups (CCG trial sites) in the East of England between 2017-18, using Public Health England data, and matched controls.

Cancer detection rates in the C the Signs trial sites reached statistical significance compared to the pre-trial year and compared to matched control sites (p<0.05).

YHEC reported, ‘…improvements in cancer detection following referrals from primary care correlate strongly with early cancer detection, this is likely to represent diagnostic stage shift in the trial CCGs’.

The health economic impact of C the Signs on cancer detection relative to comparator sites in the East of England was calculated, with a net saving of £480,071 and a Return on Investment (ROI) of 2.3. This indicates £2.30 of value for every £1.00 invested in the intervention. Beyond the economic impact, the non-cash releasing savings may contribute to relieving pressure on services or increase the ability of services to meet demand. The benefits of earlier diagnosis for patients include more positive prognosis, with higher chances of survival and less intrusive treatment.

To read the full York Health Economics Consortium report, click here.

City and Hackney

Cancer detection and referral rates

Following the implementation of C the Signs in City and Hackney CCG in 2018-19, GP practices saw a significant increase in cancer detection rates compared to the previous year, matched control sites and NHS England.

An analysis by North Central and East London Cancer Alliance also found that C the Signs had a positive effect on the number of two- week-wait (cancer) referrals and performance following implementation in City and Hackney.

To read the full NCEL’s report on C the Signs, click here.

North West London

Cancer detection during the pandemic

C the Signs was implemented across North West London CCG (NW London) during the first year of the pandemic (2020-21). A significant drop in the number of cancer referrals was seen across the UK during the pandemic, with the London region in particular experiencing a more pronounced reduction.

The table below outlines the impact C the Signs had following implementation in NW London. Despite the drop in cancer referrals (20%), the cancer detection rate in NW London was higher (50.7%) compared to the control CCG in London (44.7%) and compared to NHS England (47.8%).

A further consequence of the pandemic was a significant reduction in the number of patients who were diagnosed with cancer overall in the population (13% down on the previous year). This was due to patients not coming forward, being missed or lost to follow-up, and due to the change in the way patients were engaging with healthcare during the pandemic, which resulted in patients not being identified or diagnosed across multiple healthcare settings.

These patients were labelled as the ‘missing cancer patients’ calculated based on the expected number of cancers that should have been diagnosed.

The table below shows that the proportion of missing cancer patients in North West London (-7%) which was much lower compared to the control CCG in London (-17%) and compared to the missing cancer population across NHS England (-13%).

NW London commissioned C the Signs in June 2021, during the pandemic. Despite being launched in the midst of the COVID-19 crisis, NW London had 50% fewer missing cancer patients as compared to the control CCG in London. These additional 414 patients detected would have benefited from improved prognosis, alongside the economic benefit seen from detecting these patients earlier.

GP workload

Prior to accessing C the Signs, a survey of 711 General Practitioners (GPs) in North West London was conducted. This found:

  • 97% didn’t know what pathways they had access to
  • 69% had a two-week wait referral rejection in the previous 12 months
  • 72% spent longer than two minutes completing a two-week wait referral

On implementation of C the Signs these issues were addressed. C the Signs is fully customised to cancer pathways, and diagnostics across each hospital servicing primary care. This ensures that at point of referral GP’s are made aware of the correct pathway to use.

Each referral form is pre-populated and accessible with two clicks, taking on average 30 seconds to complete a cancer referral.

Through C the Signs smart cancer referral forms and mandatory field technology, all 2-week-wait referrals are 100% clinical appropriate – preventing rejected or downgraded referrals, and ensuring hospitals have the correct information they need for patients.

Qualitative feedback

“Superb resource: all in one place, clear and helpful. Practice dashboard and safety netting are excellent features.”

Dr Daniel Dietch – GP, NW London

“Excellent tool for helping to identify correct referral pathways and the dashboard is excellent for safety netting referrals.”

Dr Georgina Thomspon – GP, NW London

“I find C the Signs useful when completing the reviews as all the resources that are relevant to the patient and their diagnosis is in one place. The form is easy to follow and acts as a prompt on what to discuss. It saves me time looking for information for each type of cancer and other resources beneficial to patients!”

Manisha Patel – PCN Clinical Pharmacist, NW London

Somerset

Early adoption

Somerset Integrated Care System (ICS) took a novel approach to implementation of C the Signs. Making the system mandatory on deployment, C the Signs was rapidly adopted across primary care – with 50% of all cancer referrals going through C the Signs within the first month, and over 95% of all cancer referrals and activity going through C the Signs within 6 months following implementation. This approach ensured consistency across the entire ICS, a standardised approach to cancer referral criteria, pathways and access, and an immediate impact and benefit to quality of cancer referrals and outpatient capacity.

Commissioner feedback

The following feedback was provided by Dr. Angela Beattie GP & Cancer Clinical Lead in Somerset ICS:

“I found that C the signs is very, very, very good at providing support and education… If I’ve got a query from someone, it’s answered quickly and efficiently.”

“Before C the Signs, it was a bit of a mishmash as to what was being sent into secondary care. We had a meeting with C the Signs, and we went through all the referral forms, and now because of C the Signs’ mandatory fields, no referrals are ever rejected when they are sent through the system.”

Health economics

The table below looks at the past 12 months of C the Signs activity across three ICSs that are currently using the system. Specifically, this illustrates the impact of the C the Signs Cancer Risk Assessment feature, and its impact on influencing clinical decision-making and subsequent cost savings.

Over a 12-month period, 39,801 cancer risk assessments were conducted. 5.4% of the patients’ risk assessed were safely deemed not to be at risk of cancer. These patients were safely triaged by C the Signs in primary care, and unnecessary two-week wait referrals were prevented.

4.9% of the patients’ risk assessed were triaged to non-urgent pathways, removing the patients from two-week wait pathways and appropriately deprioritising them to a routine referral pathway, in line with NICE guidance.

7.4% of the patients’ risk assessed were triaged to tests first to rule in or out cancer quickly – such as Faecal Immunochemical Testing (FIT), blood tests, or X-rays instead of a two-week wait referral.

In less than 2% of instances was more than one cancer referral completed per patient following risk assessment – demonstrating the impact of C the Signs getting it right the first time.

Based on these cost savings, C the Signs can deliver a financial return on investment and break even within five to seven months of deployment.

To sign up to receive updates to C the Signs new evaluations and reports, please contact us at impact@cthesigns.co.uk