A new implementation handbook from the Getting It Right First Time (GIRFT) programme offers practical guidance and examples of best practice to support teams working to improve services for patients with pancreatic cancer.
The handbook, co-badged by Pancreatic Cancer UK and aimed at Cancer Alliances and organisations delivering pancreatic cancer care, summarises the national context for services and provides practical implementation guidance for improving performance against Cancer Waiting Times standards and increasing access to treatments.
Around 850 people are diagnosed with pancreatic cancer every month in England and survival rates are low, due in part to the fact that many are diagnosed with stage 4 cancer, when treatment options are limited. Data shows that an average of 27% of stage 4 patients receive disease-targeted treatment, but this varies from 10% to 76% between providers.
Improving outcomes and increasing access to treatment for patients with pancreatic cancer is a national priority, as reflected in the National Cancer Plan (2025). The aggressive nature of the cancer means the national ambition for diagnosis has been set at 21 days, faster than the 28-day faster diagnosis standard (FDS).
The GIRFT handbook sets out a series of checklists for key areas of service delivery, which organisations can adapt locally. These include:
- Advancing primary care awareness of symptoms: A diagnosis frequently starts with primary care, but many patients attend their GP surgery multiple times before referral and a large number are diagnosed via emergency routes. The checklist includes links to useful resources for GPs and a list of red flags that should raise suspicion of pancreatic cancer.
- Ensuring complete referrals: Making sure there is a complete, urgent and high-quality referral from primary or secondary care can reduce delays to diagnosis and treatment. The checklist advocates for agreed referral criteria and standard operating procedures (SOPs) to support consistent triage decisions to help avoid unnecessary investigations and speed up referrals.
- Demand and capacity (D&C) planning: D&C planning can identify bottlenecks and pinpoint where improvements are needed, helping services to manage and reduce backlogs. The checklist outlines actions to support successful D&C planning and links to useful planning tools.
- Cancer pathway tracking: A clear, real-time patient tracking list (PTL) helps teams identify patients at risk of breaching targets for diagnosis and treatment and ensures urgent cases move quickly through clinics, imaging, pathology and review. The checklist offers six actions to help achieve this and includes a link to the Cancer 360 tool, which can be used to understand and mitigate bottlenecks and delays in pathways.
The handbook also contains a series of detailed case studies from teams nationally who have successfully implemented changes to improve their service.
"In recent years, GIRFT has worked with other national organisations to establish a consensus on the key components of high-quality pancreatic cancer care, but we know that substantial variation still persists in access to treatment, pathways and patient outcomes. We hope this handbook is used by clinicians and operational managers to improve outcomes and experiences for people referred to pancreatic cancer services, by standardising clinical pathways and optimising the use of diagnostic capacity and resources. We are grateful to the Cancer Alliances, trusts and individuals who have contributed to the development of the case studies included in the handbook, and for allowing us to share their best practice nationally."
