Quality statement 2: Urgent direct access endoscopy for oesophageal or stomach cancer

Quality statement

People presenting in primary care with symptoms that suggest oesophageal or stomach cancer have an urgent direct access upper gastrointestinal endoscopy.

Rationale

Urgent direct access for upper gastrointestinal endoscopy is cost effective and can lead to faster diagnosis of oesophageal or stomach cancer. Early detection and diagnosis is important to successfully treat and survive cancer, and to improve the quality of life for people with oesophageal or stomach cancer.

Quality measures

Structure

Evidence of local direct access pathways to ensure that people presenting in primary care with symptoms that suggest oesophageal or stomach cancer have an urgent direct access upper gastrointestinal endoscopy.

Data source: Local data collection.

Process

Proportion of people with symptoms that suggest oesophageal or stomach cancer who have an urgent direct access upper gastrointestinal endoscopy.

Numerator – the number in the denominator who have an urgent direct access upper gastrointestinal endoscopy.

Denominator – the number of people with symptoms that suggest oesophageal or stomach cancer sent for an urgent direct access upper gastrointestinal endoscopy at the time of presentation at their GP.

Data source: Local data collection.

Outcome

a) Time to oesophageal cancer diagnosis.

Data source: Local data collection.

b) Time to stomach cancer diagnosis.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care services and endoscopy services) ensure that systems are in place for GPs to send people who present at primary care with symptoms that suggest oesophageal or stomach cancer for an urgent direct access upper gastrointestinal endoscopy.

Healthcare professionals (GPs or practice nurses) send people with symptoms that suggest oesophageal or stomach cancer for an urgent direct access upper gastrointestinal endoscopy.

Commissioners (clinical commissioning groups and NHS England) ensure services use urgent direct access to send people who present in primary care with symptoms that suggest oesophageal or stomach cancer for an urgent direct access upper gastrointestinal endoscopy.

What the quality statement means for patients and carers

People who have certain symptoms that might be caused by cancer of the oesophagus (the throat) or stomach and who go to their GP are offered a hospital procedure to look inside the throat and stomach (called an endoscopy). This is carried out and the results sent back within 2 weeks of seeing their GP.

Source guidance

Definitions of terms used in this quality statement

Direct access

When a person is sent directly by their GP for a test in a specialist service, such as imaging or endoscopy, and the GP retains responsibility for the person's care, including following up and acting on the results.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12)]

Urgent

The test should be performed and results returned within 2 weeks. When a person is sent for an urgent direct access test by their GP, the test (for example, an endoscopy) is performed and results returned within 2 weeks.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12)]

Symptoms that suggest oesophageal or stomach cancer

People should be referred for an urgent direct access upper gastrointestinal endoscopy (performed within 2 weeks) to assess for oesophageal or stomach cancer if they:

  • have dysphagia or

  • are aged 55 and over with weight loss and any of the following:

    • upper abdominal pain

    • reflux

    • dyspepsia.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12) recommendations 1.2.1 and 1.2.7]