Driving Quality Improvements in UK Lung Cancer Care - Spotlight on Manchester's SQD Programme

Following the launch of the UKLCC’s ‘Driving Quality Improvements in UK Lung Cancer Care’ Report in February, each month we will be featuring examples of good practice from different lung cancer teams across the UK.  Please share your innovation and initiatives with us via bestpractice@uklcc.org.uk

This month we have invited Prof. Matt Evison to tell us about Manchester’s successful Single Queue Diagnostics (SQD) Programme and how it is helping to reduce inequalities in access to optimal and timely care:

“The primary objective of the SQD Programme is to enhance diagnostic efficiency across the Greater Manchester Cancer Alliance - leading to better outcomes for lung cancer patients.

“Variability exists in capacity and service resilience throughout the region – and different healthcare trusts offer varying specialist diagnostic procedures. For instance, PET-CT scanners are distributed by geographical area, leading to differences in access at the trust level. Similarly, Endobronchial Ultrasound (EBUS) services are not uniformly available across all trusts.

“Median wait times for EBUS range from six to 11 days, resulting in varying patient access based on their location. The SQD Programme aims to deliver these essential diagnostics within a five-day timeframe, aligning with the GIRFT (Getting It Right First Time) target. 

“Prior to the programme’s implementation, information on EBUS waiting times across Greater Manchester was not accessible to referring teams. EBUS scheduling was the responsibility of the provider organisation, while accountability remained with the referring hospital. Patient choice was limited due to rigid referral pathways.

“However, the introduction of the SQD system has transformed this landscape. By optimising and sharing diagnostic capacity locally, patients can now select the centre for their EBUS, based on personal preferences and centre waiting times. 

“A unified digital system accessible by all centres, enables referrers to book EBUS appointments from any provider within Greater Manchester area while the patient is still sitting in the consulting room. The system simply calculates the earliest available appointment and can also coordinate appointments for different procedures, such as PET-CT scans and EBUS.

“Introducing significant changes like the SQD system is a gradual process. Over the course of three years, this system has been meticulously developed and fully implemented. 

“Key outcomes of the SQD Programme include:

"Reduced Wait Times: Under the SQD system, the median wait time for Endobronchial Ultrasound (EBUS) procedures has been impressively reduced to just five days. Importantly, all excessively long wait times (exceeding 18 days) have been eliminated. This improvement ensures timely access to essential diagnostics for patients.

"Patient Choice and Efficiency: Approximately 40% of patients are now opting for alternative providers within the system to expedite their diagnostic journey. This flexibility allows patients to choose centres based on their personal needs and available waiting times.

"Expanding Services: The SQD system continues to evolve. Thoracoscopy services are now operational, offering a convenient ‘one-stop model’ that combines clinic consultations with the actual procedure. Additionally, the imminent launch of CT-guided lung biopsy services under the SQD system addresses a critical need.

"Navigating Technical Variations: Overcoming technical variations has been a challenge. For instance, different centres may have varying protocols for biopsies. However, the SQD system promotes collaboration across thoracic radiology, ensuring that biopsy procedures are vetted and matched to the appropriate level of complexity.

"Patient Travel Costs: A crucial aspect of the programme is that patients’ travel costs are covered within the SQD framework, making it more accessible and patient centric.

“For further information about the SQD programme, you can visit: https://gmcancer.org.uk/faster-diagnosis/single-queue-diagnostics/sqd-information-for-clinicians/ Or contact  gmcancer.admin@nhs.net.”