Published on 17 November 2025
Head and Neck Cancer Direct Access Pilot
By John Pilcher, Senior Quality Improvement Manager
Cheshire and Merseyside Cancer Alliance recently completed a pilot project with the Head and Neck Centre at Aintree Hospital, Liverpool.
This was in response to research from the clinical team at the Head and Neck Centre, which identified areas across Cheshire and Merseyside with higher risk factors, based on several years of referral data, for head and neck cancer.
The Cancer Alliance, working with the Head and Neck Centre and local GPs, designed a direct access self-referral project that would enable patients with specific symptoms to contact the hospital, without the need for a GP appointment, so they could be assessed for possible head and neck cancer.
The aim was to increase the detection of head and neck cancer at an early stage in the pilot population, with a spin-off benefit of raising awareness of the signs and symptoms of head and neck cancer generally.
It was agreed that the symptoms which needed to be apparent in the patient for this self-referral to take place should be a hoarse voice and/or a neck lump for more than three weeks.
The first phase of the project was designed for anyone over the age 16 and living in the Kirkby postcode areas.
Local residents were made aware of the opportunity to contact the service through text messages sent from their GP practice, local radio advertising, social media posts and leaflets.
The results were surprising, with more than 160 patients contacting the dedicated triage telephone line, which far exceeded expectations. As a result, the team had to quickly mobilise to provide additional clinics.
Ultimately, all patients were seen but the team realised that if the pilot was to run again, the messaging needed to be clearer, and we needed to avoid giving the impression the GP had asked patients to contact the clinic, rather than just advertising the service.
The vast majority of patients seen in the clinic were experiencing symptoms related to colds and flu, but four patients required further follow up. However, no cancers were detected but it was clear the project had raised awareness of the signs and symptoms of head and neck cancer.
The project team learned the following key lessons:
- GP to patient direct text messages are extremely effective
- But… they need to be carefully worded to avoid giving the wrong impression
- The referral criteria should focus on high risk groups including age and smoking status
As a result, the team agreed to launch a second phase of the project, with the same ambition – but with different, enhanced criteria for self-referral – to encourage patients within higher risk areas to present as early as possible, if they were over 45 years old, were a current or previous smoker and had a hoarse voice or could physically feel a neck lump, for three weeks or more.
This time, the project would be based in part of Liverpool, covering the L5, L6 and L7 postcodes. Patients would be able to self-refer to the Head and Neck Centre but only if they met this new criteria.
A similar approach was taken to awareness raising, utilising GP text messages, social media but also links to patient testimonials via the Cheshire and Merseyside Cancer Alliance website. A video was created voiced by a former head and neck cancer patient who was a patient representative of the Cancer Alliance, giving simple information about the criteria.
Just under 50 patients contacted the service, which was a much more manageable number, and the clinical team were able to see everyone during the original clinics.
However, the results were similar in Liverpool to that of Kirkby, with no cancers detected and the majority of patients discharged with no follow-up required.
The aim of the project was to test if self-referral to a specialist hospital setting resulted in earlier diagnosis, especially within communities that have a higher risk of head and neck cancers. Against this aim, the team found that self-referral is not the solution so this will not be pursued as a ‘business as usual’ approach.
However, the project was successful in raising awareness of the signs and symptoms of head and neck cancer and engaged several parts of the local NHS to work together and explore how to make service provision easier to negotiate for patients.
The effectiveness of GP communications coupled with a close partnership approach to working with secondary care is a foundation to be built upon and one that we are confident will lead to better outcomes for our patients.
Cheshire and Merseyside Cancer Alliance is uniquely placed to work with NHS partner organisations to try new ways of working and find improvements and innovation that can be applied across the region.
To find out more about the project read our full assessment report here.
To find out more about head and neck cancer, see: https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer
