Effective Cancer management: framework

2. Optimal Referral

Ensuring a patient is on the right pathway at the right time is essential to ensure those at higher risk of cancer are seen and treated as quickly as possible. This is also essential for those that do not have cancer so they and their families receive reassurance as soon as possible. Fitness for treatment should be considered at the earliest opportunity with prehabilitation and brief intervention principles applied as appropriate.

2.1 Cancer pathways should be co-produced with Primary and Secondary Care Teams and signed off by the Clinical Lead for each tumour group.

2.2 Cancer pathways should be monitored closely by the tracking team and Cancer Manager to ensure patients are managed within agreed timescales from referral to treatment.

2.3 All tumour specific pathways must be reviewed, updated if required and signed-off by the tumour specific Clinical Lead annually (at a minimum), as new technologies, ways of working and treatments advance and evolve.

2.4 Boards must ensure the capacity to effectively manage the demand of urgent suspicion of cancer (USC) referrals is in place and provision can be flexed when required in times of referral variation (i.e. when breast screening mobile units are in the area or seasonal differences).

2.5 A process to release any ring-fenced USC slots must be in place to reduce the potential of lost capacity, should these urgent slots not be required.

2.6 Direct access for Primary Care to diagnostics with appropriate locally agreed referral processes must be in place.

2.7 Local arrangements should be in place for Advanced Nurse Practitioners (ANP) other nursing staff, pharmacists, dentists, optometrists, NHS24, paramedics and others to ensure their USC referrals can be made and accepted.

2.8 Secondary Care should consider all appropriate USC referrals that meet the Scottish Referral Guidelines for Suspected Cancer from the Primary Care Team.

2.9 Use of RefHelp or equivalent in Primary Care will help ensure the patient is being put on the right pathway at the point of referral.

2.10 An audit of Primary Care referrals should be undertaken in collaboration with General Practice clusters at least annually and discussed with local Cancer Management Groups to support compliance and any lessons shared.

2.11 Working with third sector groups such as Macmillan Cancer Support Scotland and Cancer Research UK to maximize the use of their well-established training packages.

2.12 Primary Care should consult with clinical guidance developed during Covid-19, to support the effective management of USC referrals, for example the USC lung guidance, published July 2020.