Framework for Effective Cancer Management (FECM)
1. What was the issue/problem identified?
For many patients, the first signs of cancer are vague and non-specific. Symptoms such as fatigue, mild discomfort, or general ill health often did not meet the criteria for an urgent suspicion of cancer (USC) referral, until recently when the clinically reviewed SRGs incorporated NSS guidance. This left patients in a difficult position: uncertain about their health, anxious while waiting for clarity, and sometimes navigating fragmented referral pathways that created inefficiencies and delayed access to investigations.
The impact of this was significant. Patients experienced prolonged anxiety while waiting for answers. Referral routes were inconsistent, often involving multiple appointments before a clear plan could be reached. In some cases, patients from deprived communities faced additional barriers, exacerbating health inequalities. NHS Fife recognised that without a more responsive pathway, too many patients would continue to face delays, distress, and missed opportunities for early diagnosis.
2. What did you do?
To address these gaps, NHS Fife launched the award-winning Rapid Cancer Diagnostic Service (RCDS) in June 2021. The service was designed to provide a clear, structured, and compassionate pathway for patients with non-specific but concerning symptoms. The approach was built around three central aims: to deliver earlier diagnosis, to make the system more efficient, and to improve patient experience.
The RCDS introduced direct access to diagnostics for GPs, supported by a centralised, patient-centred service. Patients were referred into RCDS when their symptoms did not fit a standard USC pathway but still warranted urgent investigation. Once referred, patients received a coordinated package of support, including proactive safety netting to ensure no one was lost in the system.
Crucially, patient voice was embedded into the service design. A dedicated volunteer supported patients to share their experiences via Care Opinion, creating a real-time feedback loop. This not only captured patient perspectives but also allowed the service to identify issues quickly and adapt. Patients consistently reported that they felt listened to, reassured, and supported.
3. What was the outcome?
A comprehensive evaluation by the University of Strathclyde (2021–2023) showed the clear impact of the service. Around 12% of patients referred into the RCDS were diagnosed with cancer, confirming the pathway’s role in supporting earlier detection. A further 7% were diagnosed with pre-cancer conditions, enabling closer monitoring and timely intervention. Nearly half of all patients were diagnosed with another health condition, while 34% were given the all-clear, reducing unnecessary worry and providing reassurance.
Beyond these clinical outcomes, the patient experience was strongly positive. Of 197 patient stories shared through Care Opinion, 96% expressed highly positive feedback. Patients valued the professionalism and dedication of staff, the speed of access to investigations, and the quality of communication. Many reported relief at being given clarity quickly, while others emphasised the confidence they gained from feeling supported throughout the process.
Themes from feedback highlighted how timely diagnostics reduced anxiety, how virtual appointments improved accessibility, and how robust safety netting gave patients confidence that their care was continuous and reliable. Some areas for improvement were also raised, including communication, parking, and pain management — and these are now being used to shape further refinements.
The RCDS has therefore delivered benefits on multiple levels: improving efficiency, reducing inequalities, embedding patient voice, and quickly providing reassurance for those who do not have cancer. The initiative proved highly valuable, and its learning continues to influence local practice and future planning within the service.
Contact
Murdina MacDonald, Lead Cancer Nurse - Murdina.MacDonald@nhs.scot