Table 2

Strategies to improve the waiting time system: recommendations and examples

ThemesChallenge(s) to which recommendation applyRecommended strategiesExamples
Promoting patient awareness and early presentationDelays in help-seekingHave 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 referralPatients 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 resourcesLimited capacityIncrease 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 careLack 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.