Unlike the previous DES there are no fixed requirements for this aspect. However, we would encourage PCN to build on earlier work and refer to the presentation Section 4: Tumour-specific advice for optimising 2ww referrals for some ideas.

Dr Sue Burke, formally NHS Warrington CCG Cancer GP Lead, provides an overview of the key components to consider when making a 2ww suspected cancer referral

An overview of CDS can be found here

Freely available and based on NICE NG12 cancer guidelines, the ‘Cancer Maps’ is an example of the ‘decision support’ tools referenced in the DES specification.

‘Cancer Maps’ is an interactive CDS designed to enable GPs to take symptoms that patients present with during a consultation and map them on possible suspected cancer pathways.


We are currently developing a PCN data dashboard that will be freely available and include key metrics aligned to the 21/22 DES and QOF QI

CMCA have developed a ‘Brief Cancer Audit’ template for practices to audit and review of a cohort of recent 2ww referrals. 

Download Brief Cancer Audit

The 2020/21 PCN DES specification references increasing use of Rapid Diagnostic Services (RDSs). Rapid Diagnostics Services are separated into 2 classifications:

  1. Site-specific RDSs are currently being developed and rolled out across C&M in a phased approach over the next 4 years.
  2. Non site-specific RDS’s are services for patients with vague but non-specific symptoms, as specifically referenced in the DES specification. These non-specific services are in place at Royal Liverpool, Southport and Ormskirk, Mid Cheshire, St Helens and Knowsley (Whiston), Warrington and Halton.  Services are currently being developed at Chester and Aintree with plans for Wirral and East Cheshire later in the year.

You will find access to your local non-site specific Rapid Diagnostic Service within ESR, or alternatively contact your local Acute Oncology Team.

Overview of a Rapid Diagnostic Service for patients with non-Specific Symptoms

Becki Glocke (Cancer Nurse Specialist lead for the Liverpool University Hospitals NHS Foundation Trust non-specific symptoms Rapid Diagnostics Service) explains what a non-specific rapid diagnostics service is, and how the service can benefit both patients and GPs. 

For more information on the Rapid Diagnostic Service Programme, and plans for the development of both site-specific and non-site specific Rapid Diagnostic Services in C&M during 21/22, please click here.

What is NRDS?

NSRDS provides assessment for patients who present with non-specific symptoms that could be due to an underlying cancer but where the presentation does NOT meet the current NICE NG12 referral guidance for suspected cancers.

Other potential causes must be considered and excluded prior to referral in order to be defined as ‘unexplained’ and not overlook other causes.

The referral is processed just as an urgent suspected cancer referral and is aligned to the National Cancer Waiting Times Standards.

Where are NSRDS in CMCA?

Six trust sites currently offer a NSRDS, referrals to these sites can be made through your current Electronic Referral System and attaching the agreed referral form which will ensure all of the required information is provided for optimal triage of your patient.

Work is underway with the remaining Trusts to provide NSRDS in the near future.

If you require any further ‘general information’ regarding NSRDS (ie not relating to an individual patient) contact sarah.griffiths16@nhs.net at Cheshire and Merseyside Cancer Alliance or your local service on the emails above.

Review of referral criteria and pre–referral diagnostics

  • New unexplained and unintentional weight loss (either documented >5% in three months or with strong clinical suspicion);
  • New unexplained constitutional symptoms of four weeks or more (less if very significant concern). Symptoms include loss of appetite, fatigue, nausea, malaise, bloating;
  • New unexplained vague abdominal pain of four weeks or more (less if very significant concern);
  • New unexplained, unexpected or progressive pain, including bone pain, of four weeks or more;
  • GP ‘gut feeling’ of cancer diagnosis - reasons to be clearly described at referral.

Safety netting has become increasingly important as patients become more complex and a greater number of investigations are undertaken in primary care. Safety netting is not a specific requirement of the DES in 22/23 but is recognised as being an intrinsic part of optimal referral practice.

An introduction to Safety Netting

Dr Rhian Tomas, Halton CCG Cancer GP Lead, explains what is meant by ‘safety netting’, and how practices can improve their safety netting practice. Please ignore the reference to CRUK facilitators as this resource is no longer available.

Safety netting checklist, training and templates

The toolkit, training links and templates referenced in Dr Rhian Tomas’s ‘Safety Netting’ video above are available below.

We have developed a checklist to enable you to critique your current safety netting processes.

To request a copy of the Safety Netting Template ZIP file, please email training@iMerseyside.nhs.uk

Safety Netting Checklist

Download the Safety Netting 2020 V3.1 Checklist

Training for Safety Netting 2020 V1 EMIS

There are several training resources available to support with the implementation and use of the SN template.  There is a written guide plus two training videos; one for clinical staff and one for admin staff: 

IT Support for Safety Netting 2020 V1

Information facilitators are available to support practices within South Sefton, Southport & Formby and Liverpool CCGs.

Practices from Knowsley, Halton, St Helens, Warrington, Wirral and Cheshire CCG areas will have access to remote IT support provided by Informatics Merseyside:

This remote support will be provided via email address training@imerseyside.nhs.uk

All support requirements should be emailed to the team and a trainer will contact the user within 24 hours (unless this covers a weekend/bank holiday).

The training team will only deal with support requirements directly related to the Safety Netting 2020 V1 eLearning.

Developing Safety Netting 2020 V1 & ongoing quality improvement

Critical to this locally developed safety netting template is ongoing development and feedback so any new ideas and suggestions about improvements to the template are welcomed and should be directed to Debbie.harvey1@nhs.net

Sign posting

At the time of a 2ww referral it is important that patients feel both supported and are also signposted.

Urgent cancer referral patient information, developed by Cancer Research UK, is available for download and use in your practice or PCN, to inform and reassure your patients.

Download Urgent Referral Patient Information (PDF)

When making a 2ww referral we recommend that patients are given a supportive letter. The following suggested document can be personalised for your practice and uploaded into your clinical system. The content should support any conversations and also provide evidence of safety netting around appointments. The content can be adjusted to reflect local differences

Download Supportive Patient Letter (Word)