Current standards (NHSE 2023 reform)

Standard	From	To	Threshold
28-day FDS (Faster Diagnosis Standard)	Suspected-cancer referral (or breast symptomatic / screening referral)	Communication to patient of diagnosis or rule-out	≥75%
31-day standard	Decision to treat (DTT)	First definitive treatment	≥96%
62-day standard	Suspected-cancer referral (2WW / cancer screening / consultant upgrade)	First definitive treatment	≥85%

NHS Long-Term Plan: aspirational 75% of cancers diagnosed at stage 1-2 by 2028.

Application to skin cancer

2-week wait (2WW) referral: NICE NG12 — suspected skin cancer triggers (pigmented lesion 7-point checklist, non-pigmented lesion with concerning features). Required to be seen within 14 days from GP receipt.
28-day FDS: patient must receive communication of diagnosis or exclusion within 28 days of referral.
31-day standard: where treatment is needed (e.g. WLE for melanoma, Mohs for cSCC), this should occur within 31 days of MDT decision.
62-day standard: end-to-end pathway from suspected-cancer referral to first definitive treatment within 62 days.
Surgical first definitive treatment: WLE / Mohs / lymphadenectomy.
Non-surgical first definitive treatment: radiotherapy, immunotherapy initiation (e.g. pembrolizumab Cycle 1, T-VEC, vismodegib), active surveillance start (not usually counted).
Topical 5-FU / imiquimod / cryotherapy can count as first definitive treatment in low-risk situations.

Common reasons for breach:
- Diagnostic delays (biopsy backlog, complex histology, MDT clarification).
- Patient factors (DNAs, comorbidity workup, patient choice to delay).
- Surgical capacity issues.
- Imaging / staging delays.
- Inter-provider transfer.
- Genetic / specialist referral delays.
Tracking: cancer trackers, MDT coordinators, weekly performance reports.
Reporting: trust-level NHS England CWT submissions monthly; published quarterly.
Patient-initiated pauses: clock pauses for patient choice / comorbidity but not for provider delay.
Inter-provider transfer: 38-day rule — handover by day 38 of pathway minimises 62-day breach risk for receiving SSMDT.

Document GP-referral date and patient-pathway clock-start date on every consultation.
For SSMDT receiving inter-provider transfers, ensure pathology slides / digital images and MDT minutes arrive simultaneously to enable rapid discussion.
Real-time data submission to COSD / NCRAS supports both audit and CWT reporting.
If a patient is unsuitable for definitive treatment within timeframe (frailty, comorbidity workup), document MDT decision and patient choice; treats clock-pause appropriately.
Counsel patient on expected timelines at first consultation.
Local trust cancer-manager / coordinator is the central point for tracking — engage early on suspected breaches.