Strategies to improve the waiting time system: recommendations and examples
| Themes | Challenge(s) to which recommendation apply | Recommended strategies | Examples |
|---|---|---|---|
| Promoting patient awareness and early presentation | Delays in help-seeking | Have a positive message about cancer treatments Patient education Invest in screening and early diagnosis | Adverts for cancer (area 1) |
| Review of the criteria for rapid referral | Patients not presenting with ‘red flag’ symptoms Difficulties of making referral decisions based on the criteria Delays for patients in the routine pathway or those with conditions other than cancer Complex pathway for CRC diagnosis Targets over-rode patient or clinician choice | Refine the CRC rapid referral criteria Increase GP access to investigations Referral options for patients outside the guidelines Decide on patient timelines based on clinical need or clinical suspicion of cancer Make allowances for patient choice Have a single time scale for all patients Revise the waiting time targets for CRC Change the penalties system for breaches | Feedback to GPs on results of referrals (area 3) |
| Optimise limited resources | Limited capacity | Increase capacity Have designated diagnostic centres Shift some investigations to primary care Create nurse-led clinics Have flexible or dedicated TWW lists for tests | Assignment of some investigations to primary care (area 2) Increase in the number of colorectal surgeons (area 2) Increase in endoscopy capacity (area 3) Dedicated diagnostic imaging slots (area 2) |
| Facilitate coordination of care | Lack of coordination of care Delays caused by the MDTs | Named consultant responsible for the patient once referred Automate the system Give patients appointment reminders Use of support services Obtain complete patient information Create one-stop clinics Have straight to test options Expedite the MDT process for some patients | Online referral system (Area 2) Provision of nursing support for patients (area 1) Improvement in triage of complex patients (area 1) Clearer instructions for preparation for tests (area 2) |
CRC, colorectal cancer; GP, general practitioner; MDT, multidisciplinary team; TWW, two-week wait.