Framework for Effective Cancer Management (FECM)
1. What was the issue/problem identified?
NHS Dumfries & Galloway (D&G) identified delays in patients being seen at their first clinic appointment. As Urgent Suspicion of Cancer (USC) pathways have become more complex, the Board recognised that focusing on the very front end of the cancer pathway could significantly shorten overall pathway length. This would not only improve efficiency but also reduce patient anxiety by speeding up access to care.
While NHS D&G had long maintained a robust escalation policy with a target of first clinic within 14 days, the cancer team wanted to go further. Their ambition was to reduce this wait to 7 days for most or all specialities. Achieving this required close collaboration with the Patient Focused Booking team and service management to align capacity and implement new ways of working.
2. What did you do?
To begin with, a 14-day escalation report was created and shared twice a week (Tuesdays and Thursdays) with the Patient Focused Booking team and its team leader. The cancer team worked closely with Patient Focused Booking at Dumfries & Galloway Royal Infirmary (DGRI) to ensure all patients were booked into appointments within 14 days. From there, specific cancer sites where waits could be reduced more easily were identified, and these patients began to be booked within 10 days, while the 14-day report continued to be monitored.
The Patient Focused Booking team reviewed the structure of all clinics, highlighted any issues, and escalated structural or timetable changes to senior management where needed. At the same time, the Cancer Tracking Team delivered education sessions for Patient Focused Booking staff to reinforce the importance of prioritising cancer patients and ensuring they were placed into the first available clinics.
Within four to five months, this collaborative work meant that the Board was in a position to aim for first clinic within 10 days for all cancer patients. The escalation report continued to be issued twice weekly, and after just one month of managing this new standard, the team felt confident they could go further and move towards a 7-day target.
NHS D&G then implemented a 7-day escalation report. While not all patients could be booked within 7 days, the majority were, and if a 7-day appointment could not be secured, a maximum of 10 days was always achieved.
3. What was the outcome?
NHS D&G is now able to work closely with its Patient Focused Booking team at DGRI to monitor and respond quickly to any patients falling outside of the 7-day standard. Although the system still requires active micro-management by the cancer team, the improvements achieved—and the positive impact on patients’ journeys—make it a valuable use of resources.
The Cancer Tracking Team is continuing to work hard to maintain the 7-day target, though challenges remain at times of reduced capacity such as public holidays or the festive period. Looking ahead, NHS D&G is developing a 5-day waiters report, which will provide Patient Focused Booking with earlier warning and allow time to reschedule patients at risk of breaching the 7-day target.
Contact
Christine McDowall, Cancer Performance Manager- christine.mcdowall@nhs.scot