The DES Specification outlines 4 components to ‘Referral Practice’ for suspected cancers, including recurrent cancer:

  1. Review the Quality of Referrals
  2. Safety Netting
  3. Signposting
  4. Considering unwarranted variation

Tumour-specific advice relating to optimising 2ww referrals is available in Section 4: Tumour-specific advice for optimising 2ww referrals

Referral Practice Resources

The 21/22 DES states that PCNs should review the quality of referrals for suspected cancer in line with NICE Guidelines 12 (NG12) and make use of:

  • Clinical Decision Support Tools
  • Practice-level data to explore local patterns in presentation, diagnosis of cancer
  • Using local Rapid Diagnostic Services (where available) with serious but non-specific symptoms

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

Safety netting has become increasingly important as patients become more complex and a greater number of investigations are undertaken in primary care. Safety netting also remains a key requirement of the cancer DES in Primary Care Networks and Early Diagnosis QOF QI module 21/22

The Safety Netting template, introduced in Rhian Tomas’ video and available below (‘Safety Netting 2020 V1.2’), includes the Snomed code 'cancer safety netting' for 2ww referrals 1239431000000107 which is required for monitoring purposes of the PCN DES via the national dashboard. Version 1.2 should be uploaded to incorporate the code within the template unless practices choose to add the code separately.

The 21/22 DES states that PCNs should:

"Build on current practice to ensure a consistent approach to monitoring patients who have been referred urgently with suspected cancer or for further investigations to exclude the possibility of cancer in line with NG12"

In addition, safety netting may also be included in the QOF QI work.

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.

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 and support compliance with the requirements for the Early Cancer Diagnosis PCN DES and cancer QOF QI 21/22

To request a copy of the Safety Netting Template ZIP file, please email

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.

Safety Netting Checklist

We have developed a checklist to enable you to critique your current safety netting processes and support compliance with the requirements for the Early Cancer Diagnosis PCN DES and cancer QOF QI 21/22.

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 

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.  

This IT support will be available from October 1st, 2020 until December 30th, 2021.

Developing Safety Netting 2020 V1 & ongoing quality improvement

Critical to Safety Netting 2020 is ongoing development and feedback so any new ideas and suggestions about improvements to the template are welcomed and should be directed to

Sign posting

The 21/22 DES Specification states that PCNs should:

“Ensure that all patients are signposted to or receive information on their referral including where they are being referred, the importance of attending appointments and where they can access further support”

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)

Address Unwarranted Variation

An additional component of this part of the DES is that PCN identify and implement specific actions to address unwarranted variation and inequality in cancer outcomes, including access to relevant services. The latter could be identified through local audits and data.