GP Contract 2022/23 and cancer: A guide for Primary Care Networks

What are the GP contract requirements for cancer?

GPs play a vital role in the early diagnosis of cancer and in supporting people living with cancer. There are contractual requirements to support this, which include:

  • the Quality and Outcomes Framework (QOF)
  • Investment and Impact fund (IIF)
  • Primary Care Network Direct Enhanced Service Contract (PCN DES).

We have summarised these requirements below and provided resources to support with delivery.

Quality and Outcomes Framework (QOF) requirements

The Quality and Outcomes Framework (QOF) is designed to remunerate general practices for providing good quality care to their patients and helps to fund work to further improve care.

What are the QOF requirements?

You can find the complete list of QOF requirements for cancer below.


Indicator Points Achievement thresholds
CAN001 – The contractor establishes and maintains a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non-melanotic skin cancers diagnosed on or after 1 April 2003’. 5 Not applicable
CAN004 – The percentage of patients with cancer, diagnosed within the preceding 24 months, who have a patient Cancer Care Review using a structured template recorded as occurring within 12 months of the date of diagnosis (NICE menu 2020 ID: NM205). 6 50-90%
CAN005 – The percentage of patients with cancer, diagnosed within the preceding 12 months, who have had the opportunity for a discussion and been informed of the support available from primary care, within 3 months of diagnosis (based on NM204). 2 70-90%

Further information on the QOF specification can be found on NHS England.

Giving an effective Cancer Care Review (CCR)

A Cancer Care Review is a conversation between a patient and their GP or Practice Nurse about their cancer journey, there are targets for numbers of Cancer Care Reviews to be completed in the QOF.

A CCR can help patients to:

  • talk about their cancer experiences and concerns
  • understand what support is available in their community
  • receive the information they need to begin self-supported management

We have developed resources and electronic templates for effective CCRs.

Network Contract Directed Enhanced Service (PCN DES)

The 2022/23 PCN DES has now been released and there have been updates to the Early Cancer Diagnosis service and personalised care requirements. We have outlined the requirements for cancer below.

What are the PCN DES requirements?

  • Early diagnosis of cancer

    In the 2022/23 PCN DES, there have been some updates to the Early Cancer Diagnosis service requirements. These are:

    • 8.5.1
      • A. Review referral practice for suspected and recurrent cancers, and work with its community of practice to identify and implement specific actions to improve referral practice, particularly among people from disadvantaged areas where early diagnosis rates are lower;
      • B. Work with local system partners– including the NHS England and NHS Improvement Regional Public Health Commissioning team and Cancer Alliance – to agree the PCN’s contribution to local efforts to improve uptake in cervical and bowel NHS Cancer Screening Programmes and follow-up on non-responders to invitations. This must build on any existing actions across the PCN’s Core Network Practices and include at least one specific action to engage a group with low participation locally;
      • C. Work with its Core Network Practices to adopt and embed: i. the requesting of FIT tests where appropriate for patients being referred for suspected colorectal cancer; and
        • ii. where available and appropriate, the use of teledermatology to support skin cancer referrals (teledermatology is not mandatory for all referrals).
      • D. focusing on prostate cancer, and informed by data provided by the local Cancer Alliance, develop and implement a plan to increase the proactive and opportunistic assessment of patients for a potential cancer diagnosis in population cohorts where referral rates have not recovered to their pre-pandemic baseline; and
      • E. review use of their non-specific symptoms pathways, identifying opportunities and taking appropriate actions to increase referral activity.

    Support from Macmillan

    The following resources will help you to meet the early cancer diagnosis requirements.

    Quality improvement modules

    Our early diagnosis and cancer screening modules will help you identify patients at risk of cancer, increase uptake of cancer screening and improve referral practice.

    Video mini-series

    We have created a mini-series of short videos, featuring CRUK GPs and Macmillan GPs sharing their tips and advice for delivery of the PCN DES specification for early cancer diagnosis.

    Patient information

    We have information for patients about going for tests to help manage expectations and allow them to explore the process at their own pace.

    Cancer Decision Support tool

    Our Cancer Decision Support (CDS) tool can be accessed from EMIS Web, INPS Vision, TPP SystmOne. We have created a series of videos on how to use the tool most effectively. There is also written guidance available.

  • Personalised care

    The updates to the PCN DES Around personalised care are as follows, and focus on social prescribing-community development.

    8.10.1 – By 30 September 2022, as part of a broader social prescribing service, a PCN and commissioner must jointly work with stakeholders including local authority commissioners, VCSE partners and local clinical leaders, to design, agree and put in place a targeted programme to proactively offer and improve access to social prescribing to an identified cohort with unmet needs. This plan must take into account views of people with lived experience.

    8.10.2 – From 1 October 2022, a PCN must commence delivery of the proactive social prescribing service for the identified cohort. Macmillan has created resources on social prescribing to support people living with cancer, which include: Social prescribing guidance for primary care and our 10 Top Tips for primary care: Social prescribing.

    8.10.3 – By 31 March 2023, a PCN must review cohort definition and extend the offer of proactive social prescribing based on an assessment of the population needs and PCN capacity. Shared Decision Making (SDM) on page 63.

    8.10.4 – By 30 September 2022, a PCN must ensure all clinical staff complete the Personalised Care Institute’s 30-min e-learning refresher training for Shared Decision Making (SDM) conversations on page 67. Macmillan has created 10 Top Tips for shared decision making in primary care and people living with cancer.

    8.10.5 – By 31 March 2023, a PCN must audit a sample of the PCN’s Patients’ current experiences of shared decision making through use of a validated tool and must document their consideration and implementation of any improvements to SDM conversations made as a result.

    We have created guidance for personalised care and social prescribing to help you navigate these requirements. You can also download our quality improvement module for personalised care.

    ID (Personalised Care (PC) area) Description Numerator (N) Denominator Prevalence numerator (E) Indicator type; Points; Desired Direction; Thresholds; Data source
    PC-01 Percentage of registered patients referred to a social prescribing service. Of the denominator, the number referred to a social prescribing service. Total number of registered patients. Indicator denominator. Standard Quantitative; 20; Upwards; 1.2% (LT) / 1.6% (UT); GPES

You can find the complete PCN DES requirements on the NHS England website.

Investment and Impact Fund (IIF) incentives

The Investment and Impact Fund (IIF) is an incentive scheme that rewards Primary Care Networks for delivering objectives set out in the NHS Long Term Plan and GP contract agreement. It works in a similar way to the QOF.

What is the IIF incentive?

We have outlined the IIF incentive for cancer below.


Indicator Value/Points Achievement thresholds
CAN-01 – Percentage of lower gastrointestinal two week wait (fast track) cancer referrals accompanied by a faecal immunochemical test result, with the result recorded either in the seven days leading up to the referral, or in the fourteen days after the referral. £5m / 22 points Lower Threshold:40% (22/23), 65% (23/24) Upper Threshold: 80% d

You can find more information about the IIF on the NHS website.

FIT resources can also be accessed at faecal-immunochemical-test.co.uk.

Learning and development for primary care

Safety netting e-learning

The North Central London Cancer Alliance (formerly UCLH Cancer Collaborative) has developed an electronic toolkit to support GPs with safety netting in cancer-related clinical situations. The toolkit helps support GPs to:

  • schedule diary reminders in their system
  • receive alerts to follow up with a patient at a later date
  • share information with patients.

The toolkit can be accessed nationally by any GP practice using EMIS Web.

Macmillan Learning and Communications Hub

You can access courses and resources for primary care on the Macmillan Learning and Communications Hub. Learn about our courses and how to sign up.

Gateway C

Gateway C is a free online cancer education platform for primary care professionals across England. It aims to improve cancer outcomes by facilitating earlier diagnosis and improving the patient experience. Their courses and webinars assist users to confidently identify, refer and support patients with symptoms on a suspected cancer pathway. They have courses on specific cancers and types of early detection testing (FIT and PSA), which feed into the PCN DES requirements for 2022/23. They also have a course on supporting patients, which contains information on social prescribing.

Cancer Research UK

Cancer Research UK have also released guidance on delivering the PCN DES.

Other useful resources

10 Top Tips for primary care

We’ve created our 10 Top Tips series to help primary care professionals support patients at every stage of the cancer pathway. The tips are designed to showcase best practice and offer practical advice for your role. We have tips for:

NHS England

NHSE has released guidance for meeting the DES early cancer diagnosis requirements.