Updating the 2 week referral forms in accordance with new NICE guidance

In June 2015 the new NICE NG12 clinical guideline for suspected cancer was published, and Dr Katie Elliott on behalf of the Cancer in the Community Group undertook a major exercise in leading the updating of referral forms. Working with lead GPs, network staff and cancer unit managers, and in partnership with all network site specific groups (including lung, lower GI, upper GI, hepato-pancreato-bilary, breast, gynaecological, urological, skin, head and neck, thyroid, brain and central nervous system, haematological and sarcoma), the new referral forms were formatted and regional implementation planned. The work has involved meticulous re-drafting, as well as reviewing of referral pathways to accommodate new referral options, such as straight to testing.

This whole process has helped to stimulate conversations between clinicians, managers and GPs within and between geographical areas. It is intended that the single referral forms will help to reduce regional variation in access to services and stimulate discussion about service provision and pathways. There is potential to build on this work and to improve the use of 2 week referral by:

• Educating and updating primary care teams
• Using implementation tools that have been developed for practices to import the new forms to their clinical systems and to teach staff how to use them
• Benefiting from brief guidance that can be modified and updated – on NECN website
• Adoption of the new forms and deactivation of any other 2ww forms currently in use – also on NECN web site.

It is hoped that the integration of the forms in the GP clinical systems will:
• Improve the quality of the clinical information provided on the referral
• Reduce chance of delay for patients by : prompting clinicians to do blood tests if required and, pulling through relevant required information on to the referral so secondary care can direct patients straight to test where appropriate
• Provide a clear audit trail without additional work to scan completed paper referrals
• Reduce risk of a referral being rejected because it is not on the correct form

Implementation is being supported by the CRUK facilitators and 2ww patient information leaflets – updated documents for each trust are being stored on the NECN web site. Each new referral form has a hyper-link so that the appropriate patient leaflet can be selected. The cancer leads are working with the learning disability network to produce an ‘easy read’ version of this information leaflet for each trust.