On World Cancer Day, the government published something healthcare professionals have been waiting for since 2015: a National Cancer Plan for England. The headlines focused on the big numbers – 80% of patients diagnosed within 28 days by 2029, 85% starting treatment within 62 days, 320,000 lives saved over the plan's lifetime. These are serious commitments, and getting there will require serious investment in diagnostics, treatment capacity and specialist staff.
But there's something curious about the conversation around this plan. While everyone's talking about radiotherapy machines, robotic surgery and AI-powered diagnostics, there's been remarkably little discussion about where most cancer journeys actually begin: the GP surgery.
Over six in ten patients begin their cancer journey at the GP. Primary care is directly involved in the initial diagnosis of more than 85% of all cancer cases. For the government's ambitious targets to mean anything in practice, we need to talk about what happens at that critical first step.
The 28-day Faster Diagnosis Standard sounds straightforward enough: get patients a diagnosis or the all-clear within 28 days of referral. Currently, the national average sits at around 75%, with significant regional variation. The best-performing areas – like Shropshire, Telford and Wrekin at 86% – show it's achievable.
But here's what often gets missed in the discussion: that 28-day clock doesn't start when symptoms appear, or even when the patient first visits their GP. It starts when the referral is made. Everything that happens before that moment – the quality of information gathered, the completeness of the referral, whether it goes to the right specialty – directly affects whether that target gets met.
Consider what happens when a referral arrives incomplete. The specialist clinic needs to request additional information. The patient might need to be brought back for tests that should have happened in primary care. The appointment gets delayed while everyone waits for missing results. None of this delay counts against the 28-day target, but it absolutely affects whether patients get diagnosed and treated quickly.
This isn't about blaming GPs. Cancer diagnosis in primary care is genuinely difficult. Most cancers present with common symptoms – persistent cough, non-specific abdominal pain – that are far more likely to represent benign disease than malignancy. A full-time GP might see two or three new cancer diagnoses per year, while dealing with hundreds of patients presenting with similar symptoms who don't have cancer.
What it is about is recognising that the quality of referral pathways matters enormously to the plan's success.
The National Cancer Plan promises to address the postcode lottery in cancer care. Currently, if you live in the best-performing area for the 62-day treatment standard, you've got roughly twice the chance of starting treatment on time compared to someone in the worst-performing area.
Some of this variation is about diagnostic capacity and specialist resources. But some of it comes down to variation in referral processes and pathways. When every practice, every ICB, every specialty designs their own approach, you get variation in outcomes. The patients in areas with well-designed, standardised referral pathways get diagnosed faster. The ones in areas still relying on free text forms and inconsistent processes don't.
The government's focus on standardisation over variation – a core theme of the 10 Year Health Plan – applies just as much to referral processes as it does to treatment protocols. You can't eliminate the postcode lottery in cancer outcomes without eliminating it in cancer referral quality.
There's a frustrating irony in all of this: we already know what works. Cancer Research UK has been highlighting for years that primary care has a vital role in early diagnosis. The evidence base exists on which information matters, which red-flag symptoms require action, and how to structure referral pathways to minimise delays.
The challenge isn't knowledge – it's implementation. It's ensuring that every referral, from every practice, captures the information that specialists need to triage appropriately. It's making sure that patients don't fall through gaps because a form wasn't completed fully, or crucial test results weren't included, or the referral went to the wrong specialty in the first place.
Some areas have got this right. Where trusts have implemented structured referral pathways with mandatory fields and clinical decision support, inappropriate referrals have dropped dramatically while diagnosis times have improved. The evidence is there. It just needs to scale.
Here's what concerns me about the National Cancer Plan: it's heavy on ambition and light on implementation detail. Cancer Research UK made this point in their analysis – we need robust plans that clearly set out who is responsible for delivering each part, and by when. Without that, ambitious targets remain just that: ambitions.
The same applies to referral quality. The plan talks about productivity, diagnostic capacity, and funding for Cancer Alliances. All necessary. But productivity gains mean nothing if referrals are still being bounced back for missing information. Diagnostic capacity doesn't help if patients are being sent to the wrong specialty. Funding won't fix processes that haven't been designed properly in the first place.
If we're serious about meeting these targets – and we should be, because lives depend on it – then we need to be just as serious about the fundamentals. That means talking about referral quality, pathway standardisation, and making sure that every patient's journey starts with complete, accurate, actionable information.
The National Cancer Plan could be a turning point for cancer care in England. But only if we're willing to focus not just on the dramatic innovations, but on getting the basics right. Sometimes the unglamorous work – standardising referral processes, capturing complete information, reducing unnecessary variation – is exactly what makes the difference between targets met and targets missed.
And when the target is saving 320,000 lives, getting the basics right isn't optional. It's essential.
Want to discuss how SMART referrals can support equitable access in your organisation? Get in touch – hello@dxs-systems.co.uk.
