Urgent Referral Pathways

This section outlines essential information and resources concerning Urgent Suspected Cancer Referrals, as recommended by the NICE NG12 guidelines. You will find details about tools designed to clarify and simplify the guidance, making it easier to interpret and apply in clinical practice. There are also resources for the local Cheshire & Merseyside Cancer Alliance Urgent Suspected Cancer Referral proforma, along with electronic resources for templates that can be used in Practice Computing Systems.

Introduction to Urgent Referrals Pathways

NG12 are National Guidelines developed to support primary care in the recognition and referral of suspected cancer. The guidelines are used by primary care professionals in England and Wales.
Following the original NICE NG12 guidance, the term that was once known as the 2 Week Wait Referral, have now been replaced by Urgent Suspected Cancer (USC) Referral, as the two-week wait deadline for Secondary Care was removed following changes made by NHSE in October 2024.
Using the guidelines in primary care helps ensure people are referred along the right route, at the right time, supporting timelier and earlier cancer diagnosis¹.
They now use lower PPV thresholds of 3% for symptoms for adult cancer, and even lower in childhood cancer and for recommending primary care tests².
The Faster Diagnosis Standard has been introduced to ensure patients who are referred for suspected cancer receive a timely diagnosis. The standard ensures patients will be diagnosed or have cancer ruled out within 28 days of being referred urgently by their GP for suspected cancer. The Faster Diagnosis Standard will apply to patients:
- Referred by their GP on a suspected cancer pathway.
- Referred by their GP with breast symptoms where cancer is not initially suspected.
- Referred by the National Screening Service with an abnormal screening result³.

1. NICE Suspected Cancer- Recognition and referral

The official NICE Guideline (NG12) for suspected cancer referral provides a brief overview including identifying children, young people and adults with symptoms that could be caused by cancer. It outlines appropriate investigations in primary care, and the selection of people to refer for a specialist opinion. It aims to help people understand what to expect if they have symptoms that may suggest cancer. It also has a downloadable PDF.

Time to read: approx. 1 hour

2. Cheshire & Merseyside Cancer Alliance Urgent Suspected Cancer Referral Resources

Urgent Suspected Cancer (2WW) Referral Forms:

Urgent Suspected Cancer (2ww) Referral Forms

EMIS Consultation Templates with Cancer Guidance:

Consultation Templates with Cancer Guidance

3. GatewayC – Cancer maps

An RCGP award-winning referral algorithm that supports the NICE NG12 guidance. The interactive tool makes it easy to recognise and refer suspected cancer cases and is intended to be used during a consultation. You can identify the correct pathway in just a few clicks. The link includes a cancer maps brief video tutorial along with access to the maps.

Cancer Maps - GatewayC

(Free access, login required)

Time to read / watch: approx. 10 minutes

4. Red Whale – NICE suspected cancer guidelines summary

The Red Whale: NICE guidance for urgent referrals of suspected cancers can be used during a consultation – starting with the patient’s presenting symptom(s). This may suggest several possible cancer diagnoses. You then cross-reference symptoms to the guideline for each cancer suggested. If the patient presents with multiple symptoms, look at the guideline relating to each symptom.

(Login required – see PrOCEDE intro for details)

Time to read: approx. 20 mins

5. GatewayC Course: Improving the Quality of your Referral

The GatewayC: Improving quality of referrals online course aims to support healthcare professionals in making clinically appropriate suspected cancer referrals and preparing patients. It includes specialist discussions alongside examples of patient communication and a range of activities to reinforce learning points. CPD certificate available upon completion.

(Free access, login required)

Time to watch: 1 hour

6. Cancer Research UK – Suspected Cancer Referral Guidelines

The CRUK: Suspected cancer referrals guidelines includes evidence-based information and resources designed to support primary care health professionals with making suspected cancer referrals in line with the relevant national guidelines. It links to supporting tools (printable guides and on-line resources) for clinicians and patient information letter ‘your urgent suspected cancer referral explained’. It also includes ‘top tips’ for referrals and a brief video on a GPs perspective on referrals.

Time to read including links: approx. 20 mins