A Registrar Survival Guide - Two-week referral

GPs have a crucial role in the detection of cancer, and one of the most important tools for this is the 'two-week referral' guideline.

Two-week referrals: the rules are not necessarily exhaustive (Photograph: SPL)
Two-week referrals: the rules are not necessarily exhaustive (Photograph: SPL)

The following tips will help you use it effectively and efficiently.

Keep the guidelines handy
Most parts of the UK have a locally produced document with all the two-week referral criteria for each specialty. Make sure yours is easily accessible at all times including during consultations, so you can refer to it immediately after seeing a patient.

Make sure the patient understands
Be unambiguous about the nature of the referral with the patient.

Patients sometimes find out that a clinical suspicion existed only after their hospital appointment. This is understandably distressing, and often leads to anger and shock.

Essentials checklist
  • Easily accessible two-week referral guidelines.
  • Regular audit of your referrals.
  • An ability to use 'urgent' referrals when needed.

Use 'urgent' referrals where appropriate
Like all guidelines, the two-week referral rules are not necessarily exhaustive and you may have patients in whom you suspect cancer, but who do not fit the specific two-week criteria. In such cases, you could write a referral letter and mark it as an 'urgent referral', or even call the consultant for advice.

Audit your referrals
This will help identify your strengths and weaknesses and help improve your daily practice. For example, you may find that the majority of your respiratory two-week referrals do have cancer, but that most of your gynaecology patients do not have cancer.

Safety net and follow-up
Always advise patients to contact you if they have not heard from the hospital within two weeks. This will help ensure that the referral is definitely followed through notwithstanding any administrative problems, and could also be helpful from a medico-legal perspective if needed. It is good practice to see the patient after the diagnosis to offer emotional and psychosocial support.

  • Contributed by Dr Hamed Khan, a GP in south London

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