Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

    Contextual Overview
  1. In terms of cancer waiting times, the Department of Health require information on waiting times for all PATIENTS urgently referred by their GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER for suspected cancer by tumour site to monitor the following targets:

    The "two week wait" from the date of decision to refer to the time the patient was seen by cancer specialist services, as described in the White Paper 'The New NHS'.
    The maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
    The maximum one month wait from diagnosis to treatment for Breast Cancer.
    The maximum two month wait from urgent GP referral to treatment for Breast Cancer.

    These targets are described in the NHS Cancer Plan, published in September 2000.

  2. The QMCW will monitor performance against these targets.

  3. Completing Return QMCW - Cancer Waiting Times - Monitoring the Targets
  4. QMCW is a quarterly return, the first quarter starting on 1 April and the last quarter ending on 31 March. Returns must be submitted by the twenty fifth working day after the end of the quarter. It comprises 5 parts:

    Part One: Urgent referrals received within 24 hours
    Part Two: Urgent referrals not received within 24 hours
    Part Three: Guarantee of maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
    Part Four: Guarantee of maximum one month wait for all referrals from diagnosis to treatment for Breast Cancer
    Part Five: Guarantee of maximum two month wait from GP referral to treatment for Breast Cancer
  5. QMCW is completed by the NHS TRUST where the patient is first seen for Parts One and Two and where the first definitive treatment is administered for Parts Three to Five.

  6. The QMCW return requires the ORGANISATION CODE and ORGANISATION NAME of the NHS TRUST as well as the name of a contact, the contact's job title and the contact telephone number and fax number on the front page.

  7. Parts One and Two
  8. Comprehensive information on defining the two week standard can be found in the following Health Service Circulars:

    HSC 1998/242
    Breast Cancer Waiting Times - Achieving the two week target
    HSC 1999/084
    Collection of information on waiting times for suspected breast cancer patients in 1999/2000
    HSC 1999/205
    Cancer Waiting Times. Achieving the two week target
  9. PATIENTS are included on the return where the DATE FIRST SEEN is during the period of the quarter covered by the return.

  10. Parts One and Two comprise 13 main lines (Lines (a) - (m)) to report separately on PATIENTS with different forms of suspected cancer. These are URGENT CANCER REFERRAL TYPES.

  11. Section a: Breast Cancer
    Section b: Children's Cancers (these are PATIENTS under 16 years of age)
    Section c: Lung cancer
    Section d: Haematological Malignancies and Acute Leukaemia
    Section e: Upper Gastrointestinal Cancers
    Section f: Lower Gastrointestinal Cancers
    Section g: Skin Cancers
    Section h: Gynaecological Cancers
    Section i: Brain/Central Nervous system Tumours
    Section j: Urological Cancers and Testicular Cancer
    Section k: Head and Neck Cancers
    Section l: Sarcomas
    Section m: Others
  12. Totals for all cancers under these sections are included at the bottom of the form.

  13. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from General Medical Practitioner or 92 General Dental Practitioner and CANCER REFERRAL PRIORITY TYPE 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner. These requests can be written or verbal, and can include those sent by electronic mail or using a telephone direct booking system.

  14. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

  15. For monitoring purposes Parts One and Two require information on referrals to distinguish between those referrals received within 24 hours of the CANCER REFERRAL DECISION DATE (by end of the next calendar day) and those which were not. The REFERRAL REQUEST RECEIVED DATE should be used by the NHS Trust to calculate this interval.

  16. Part Three
  17. Part Three monitors the waiting time in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse for Children's Cancers, Testicular Cancers and Acute Leukaemia to the date of the first definitive treatment if it is within the quarter.

  18. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from General Medical Practitioner or 92 General Dental Practitioner and CANCER REFERRAL PRIORITY TYPE of 01 Urgent referral for suspected cancer from a General Medical Practitioner or a General Dental Practitioner with a PRIMARY DIAGNOSIS (ICD) of Children's Cancer, Acute Leukaemia or Testicular Cancer.

  19. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

  20. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

  21. Part Four
  22. Part Four monitors the waiting time in calendar days from the date of the diagnosis to the date of the first definitive treatment for all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of 01 Suspected breast cancer.

  23. The date of diagnosis is taken to be the date that the decision was made to treat the patient, which is the DECISION TO TREAT DATE.

  24. As with Part Three, the date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

  25. Part Five
  26. Part Five monitors the waiting time in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer for Breast Cancer to the date of the first definitive treatment if it is within the quarter.

  27. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and a CANCER REFERRAL PRIORITY TYPE of 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner with an CANCER REFERRAL DECISION DATE and a PRIMARY DIAGNOSIS (ICD) of Breast Cancer.

  28. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

  29. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

  30. Waiting Times for Parts One and Two
  31. The waiting time is measured in calendar days from the date that the CANCER REFERRAL DECISION DATE to the DATE FIRST SEEN. Note that all out-patient referrals for suspected cancer where the first attendance is for endoscopy should be in Parts One and Two.

  32. Patients who refuse an offer of an appointment
  33. DSCN 23/2000 provided the following guidance on these Patient refusals:

    "Patient's views should be considered when monitoring the two week rule and some patients might, for social or personal reasons, decline an appointment within 14 days. The waiting time of these patients who are offered an appointment but turn it down should be calculated from the date of the last appointment they were offered."

    and

    "If a patient makes it clear that they do not want an appointment within 14 days before an offer is made, e.g. because they are going on holiday, the patient should be excluded from the QMCW return and monitoring of the 'two week' standard until the date when they become available for an appointment."

    Both of the above are not currently supported by the NHS Data Dictionary and local arrangements for calculation of waiting times based upon the above guidance will be necessary until fully supported by the NHS Data Dictionary.

  34. Patients who do not attend their out-patient appointment
  35. For PATIENTS who fail to attend, whether giving advance notice or not, the waiting time will be adjusted. This is the WAITING TIME ADJUSTMENT (FIRST SEEN).

  36. PATIENTS who are referred back to their GP after failing to attend should only be counted again for Parts One and Two when they are re-referred for an urgent cancer referral. The waiting time should be calculated from the latest CANCER REFERRAL DECISION DATE of the re-referral.

  37. Waiting times for Parts Three and Five
  38. The waiting time is measured in calendar days from the CANCER REFERRAL DECISION DATE to the date of definitive treatment (See Paragraph 15, above).

  39. If the patient fails to attend or defers treatment, the waiting time will be adjusted. If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

  40. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

    WAITING TIME ADJUSTMENT (FIRST SEEN) records the number of days that should be removed from the derived waiting time between the CANCER REFERRAL DECISION DATE and DATE FIRST SEEN.
    WAITING TIME ADJUSTMENT (DECISION TO TREAT) records the number of days that should be removed from the derived waiting time between DATE FIRST SEEN and DECISION TO TREAT DATE.
    WAITING TIME ADJUSTMENT (TREATMENT) records the number of days that should be removed from the derived waiting time between DECISION TO TREAT DATE and start date of the FIRST DEFINITIVE TREATMENT PROVIDED.

    If the patient is responsible for the delay in the start date of the treatment for any of these waiting time periods, the waiting time is calculated as the start date of the first treatment minus the CANCER REFERRAL DECISION DATE minus the sum of the three waiting time adjustments above.

  41. Waiting times for Part Four
  42. The waiting time is measured in calendar days from the DECISION TO TREAT DATE to the date of definitive treatment.

  43. If the patient fails to attend or defers treatment, the waiting time will be adjusted, this is the WAITING TIME ADJUSTMENT (TREATMENT). If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.