Dermatology Faster Diagnosis Standard clarification guidance
This guidance provides additional clarification to the recording of the Faster Diagnosis Standard for patients referred on the Suspected Skin Cancer pathway, and is supplementary to Cancer Waiting Times Guidance version 11.
Appendix 1 of this document includes the relevant section of the Cancer Waiting Times Guidance version 11, to which this document refers to.
Key clarifications
Faster Diagnosis Standard reporting is trigged by the Cancer Faster Diagnosis Standard End Date, so this should be recorded for all patients unless excluded from the standards in which case the Cancer Faster Diagnosis Pathway Exclusion Reason field should be completed.
The Faster Diagnosis Standard calculation records the time from referral received (Cancer Referral To Treatment Start Date) until communication of either cancer being confirmed or cancer excluded (Cancer Faster Diagnosis Standard End Date) unless a decision to treat (Treatment Start Date (Cancer)) is present before this date in which case this is used for the calculation.
For suspected skin cancer, whether a decision to treat date should be recorded for a procedure, would be based on the intention of the procedure, and would apply to both those diagnosed with a reportable cancer and those who had cancer excluded. For those where the intention is diagnostic only (such as punch biopsy where a complete excision is not intended) a decision to treat would not be recorded, whilst if the intention is to fully excise or debulk a lesion with a procedure a decision to treat would be recorded.
The treatment date (Treatment Start Date (Cancer)) would only be recorded where a patient is diagnosed with a reportable cancer - as described in section 6.10 of Cancer Waiting Times Guidance version 11 for skin.
Faster Diagnosis Standard flow chart - Suspected Skin Cancer
Example 1
Full excision of lesion at first attendance, patient has reportable cancer (such as Melanoma)
Urgent Suspected Cancer Referral received 20 September 2021
Patient seen in clinic on 30 September 2021 – decision taken to fully excise a lesion
Excision is undertaken on same day – 30 September 2021
Pathology reported – Melanoma confirmed – 10 October 2021
Patient seen in clinic – told they have melanoma – 20 October 2021
The following would be recorded for this patient:
- Cancer Referral To Treatment Start Date – 20 September 2021
- First Date Seen – 30 September 2021
- Faster Diagnosis Standard End Date – 20 October 2021
- Cancer Treatment Period Start Date – 30 September 2021
- Treatment Start Date (Cancer) - 30 September 2021
The Faster Diagnosis Standard in this case would be reported in October as the Faster Diagnosis Standard End Month was reported on the 20 October 2021.
The waiting time against the Faster Diagnosis Standard would be recorded as 10 days, the difference between referral received (20 September 2021) and decision to treat (30 September 2021) as this is before the point at which the patient is told they have cancer.
Example 2
Full excision of lesion at first attendance, patients does not have a reportable cancer (such as basal cell carcinoma)
Urgent Suspected Cancer Referral received 20 September 2021
Patient seen in clinic on 30 September 2021 – decision taken to fully excise a lesion
Excision is undertaken on same day – 30 September 2021
Pathology reported – basal cell carcinoma confirmed – 10 October 2021
Patient seen in clinic – told they have basal cell carcinoma – 20 October 2021
The following would be recorded for this patient:
- Cancer Referral To Treatment Start Date – 20 September 2021
- First Seen Date – 30 September 2021
- Faster Diagnosis Standard End Date – 20 October 2021
- Cancer Treatment Period Start Date – 30 September 2021
- Treatment Start Date (Cancer) - Not recorded
The Faster Diagnosis Standard in this case would be reported in October as the Faster Diagnosis Standard End Date was reported on the 20 October 2021.
The waiting time against the Faster Diagnosis Standard would be recorded as 10 days, the difference between referral received (20 September 2021) and decision to treat (30 September 2021) as this is before the point at which the patient is told they don’t have a reportable cancer.
Example 3
Patient has punch biopsy intended just for diagnostic purposes at first attendance, patients does not have a reportable cancer (such as basal call carcinoma)
Urgent Suspected Cancer Referral received 20 September 2021
Patient seen in clinic on 30 September 2021 – decision taken to do punch biopsy
Punch biopsy is undertaken on same day – 30 September 2021
Pathology reported – basal call carcinoma confirmed – 10 October 2021
Patient seen in clinic – told they have basal call carcinoma – 20 October 2021
The following would be recorded for this patient:
- Cancer Referral To Treatment Start Date – 20 September 2021
- First Seen Date – 30 September 2021
- Faster Diagnosis Standard End Date – 20 October 2021
- Cancer Treatment Period Start Date – Not recorded
- Treatment Start Date (Cancer) - Not recorded
The Faster Diagnosis Standard in this case would be reported in October as the Faster Diagnosis Standard End Date was reported on the 20 October 2021.
The waiting time against the Faster Diagnosis Standard would be recorded as 30 days, the difference between referral received (20 September 2021) and Faster Diagnosis End Date (20 October 2021) as this is before the point at which the patient is told they don’t have a reportable cancer.
Appendix 1 – Relevant extract from Cancer Waiting Times Guidance version 11
3.4.8 Ending the faster diagnosis standard pathway before diagnosis
In most cases, the pathway will end when the patient is informed that the possibility of cancer has been ruled out or that they have been diagnosed with cancer.
However, there may be cases where a decision to treat is made before a diagnosis is made and communicated to the patient, for example, skin or ovarian cancers.
In such cases the Cancer Treatment Period Start Date should be recorded as the decision to treat date. Then once the patient is told their diagnosis post treatment, the Cancer Faster Diagnosis Pathway End Date should be recorded as the date of communication with the patient.
For reporting purposes the Cancer Faster Diagnosis End Date will be used to derive the reporting month, with the Cancer Treatment Period Start Date being used for the calculation where this is before this date.
The activity would be allocated to the provider communicating the diagnosis or ruling out of cancer even if the decision to treatment occurred at another trust. The Cancer Faster Diagnosis End Date should still be recorded as the date of the diagnosis of cancer or ruling out of cancer is communicated to the patient.
Last edited: 11 October 2021 12:42 pm