Hospital imaging capacity and cancer diagnoses in primary care

Early diagnosis is key for a successful treatment of cancer. General practitioners (GPs) in primary care are the first point of contact for almost 90% of all patients later diagnosed with cancer. Patients visiting their GPs at early stages with obvious alert symptoms and being urgently referred for specialist investigations have substantially higher chances of survival.

A key driver of successful earlier diagnoses is clearly represented by the responsiveness, capacity and accuracy of specialist investigations, above all diagnostic imaging scans (X-ray, Computed Tomography [CT], Magnetic Resonance Imaging [MRI], Positron Emission Tomography [PET]). However, England lags behind most OECD countries in terms of stock of imaging equipment per capita, and much of the existing stock is old and at increased risk of malfunctioning or poor performance due to a growing maintenance backlog and lack of investments in new equipment. Additionally, the NHS is facing a severe shortage of skilled technical and diagnostic personnel. The geographic areas most affected are likely more deprived and at higher need. All these trends have accelerated since the onset of the COVID-19 pandemic, despite the political discourse about increased investments in the NHS.

The evidence on how much primary care cancer referrals are influenced by these hospital-level factors is limited and vaguely related to diagnostic capacity. How these bottlenecks affect cancer diagnoses in primary care, and whether they exacerbate inequalities, are open empirical questions. We aim to shed light on this underexplored aspect of primary care activity, analysing the relationship between hospital-level capacity of diagnostic imaging (MRI, CT and PET scans) and GP-level performance indicators of cancer-related activity. We aim to achieve this answering three main questions.

Firstly, what is the current capacity to deliver diagnostic imaging to diagnose breast, lung and prostate cancer across diagnostic imaging units in the English NHS?

Secondly, what is the effect of hospital-level maintenance backlog, stock of equipment, productivity, and availability of technical and diagnostic staff on indicators of cancer-related and diagnostic activity in primary care (referral volumes, conversion rates of referrals into diagnoses, population rates of early diagnoses, waiting times)?

Thirdly, how much of the gap between the current performance and the NHS long term plan goal of diagnosing 75% of cancer at early stages can be attributed to (1) gaps in primary care cancer referral activity; (2) limited investments in new and maintenance of current diagnostic imaging equipment; and (3) staffing limitations in diagnostic services?

We aim to address these questions using a quantitative approach, building on various administrative data sources with nationwide coverage on hospital activity, hospital workforce, NHS maintenance backlog and investments, primary care activity and performance, as well as patient and population-level indicators of morbidity, incidence, and use of services.

Amount Awarded: £50,001