- Import the most up to date urgent suspected cancer (2 week wait) referral proformas archiving and deactivating the older obsolete versions.
- All clinical staff to refer patients using the most up to date proformas, including the referrer’s name and date.
- Ensure that the practice has undertaken specific steps (e.g. at induction) that all locums and G.P. trainees are aware of the 2ww referral process and comply with this best advice.
- Complete the form with due diligence, ensuring the maximum amount of information is available to help both the patient and the hospital team.
- Check demographic details are correct, ensuring current mobile number/daytime telephone contact numbers are included. Please add an email address if possible.
- Capture the relevant consultations, problems, results, medication, allergies and add any other important clinical information.
- Complete the referral process within 24 hours of seeing the patient.
- Use the E referral system (eRS) following local processes and guidelines.
- Inform the patient that they are on a suspected cancer 2WR pathway.
- Tell them that they will receive an urgent appointment at the soonest available site.
- Inform the patient that it is important they attend this appointment.
- Document if a patient is on holiday in the next 2 weeks and state the date when the patient is back and available to attend an appointment.
- If the patient is unavailable, e.g. because of holiday, you may delay organising the referral providing the patient is informed and there is a safety netting system in place to ensure the referral is sent when the patient will be available to attend.
- Provide to the patient the written, or email the electronic, information about the 2ww pathway.
- Display relevant posters/leaflets or TV advertisement in the waiting area encouraging patients to attend their 2ww appointment.
- Comply with your current local 2ww DNA/ cancellations policy.
- Act as advocate for particularly vulnerable groups, e.g. supporting patients with cognitive difficulties who are on a cancer pathway to try to ensure the patient engages with the hospital.
- Each practice has a designated non clinical cancer champion to support patients.
- Contact all patients 7 days after 2ww referral is made to ensure appointment/attendance.
- Use EMIS/CRUK safety netting system.
- Discuss with tumour lead consultants about cases of concern that do not necessarily meet 2ww criteria. Consider use of advice and guidance.
- G.P. will reflect on any clinical advice from consultants on other management options and, if necessary, change future practice, sharing the advice with colleagues.
- Consider communicating with Acute Trusts about patient concerns on a delay in their assessment.
- Practices to have policy in place to receive, record and, if appropriate, act on correspondence from hospital. This includes a practice specific plan for locums, trainees and absent doctors as hospital letters will be addressed back to the original referrer.
Responsibility to patients
- All primary care clinicians to take responsibility to act on results from investigations they have arranged that highlight a suspicion of cancer. (The consensus from G.P feedback was that practices should read results within 3 working days and act on suspicious results within 1 working day for tests they initiated).
- Ensure a safety netting process is in place for patients with any symptom with an associated increase risk of cancer who do not meet the criteria for referral or investigation. The review could be either planned within a specific time agreed with the person, or patient‑initiated if new symptoms develop, the person continues to be concerned, or their symptoms recur, persist or worsen.
- Primary care clinicians to follow the cancer pathways and local advice on each tumour referral form.
- Primary care clinicians to follow local guidance GP access to urgent diagnostic test for suspected cancer.