Section 1: Referral Practice

The DES Specification outlines 3 components to ‘Referral Practice’ for suspected cancers, including recurrent cancer:

1)    Review the Quality of Referrals

2)    Safety Netting

3)    Signposting

Note: This ‘Referral practice’ sections overlaps with the QOF QI indicators

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

Reviewing the Quality of Referrals Resources

Referral Practice Resources

The 20/21 DES states that PCNs should:

-       Review the quality of referrals for suspected cancer in line with NICE Guidelines 12 (NG12)

-       Encourage the use of:

o   Clinical Decision Support Tools

o   Practice-level data to explore local patterns in presentation, diagnosis of cancer

o   Using local Rapid Diagnostic Services (where available) with serious but non-specific symptoms

  • "Making a good referral"

Dr Sue Burke, NHS Warrington CCG Cancer GP Lead, provides an overview of the key components to consider when making a referral. 

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

  • "Cancer Maps" (Clinical Decision Making tool)

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

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

Link to Interactive reference tool (Gateway C)

  • Practice level data: Audit template

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

Download Brief Cancer Audit (Excel file)

  • Rapid Diagnostic Services

 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 RDSs 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 and St Helens and Knowsley (Whiston).  Services are currently being developed at Aintree, Warrington and Halton Hospital. 

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.  


Safety Netting Resources

Safety Netting Resources

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 a key requirement of the cancer DES in Primary Care Networks and Early Diagnosis QOF QI module 20/21.

The 20/21 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”


An introduction to Safety Netting

Dr Rhian Tomas, Halton CCG Cancer GP Lead and CRUK GP, explains what is meant by ‘safety netting’, and how practices can improve their safety netting practice. 

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 20/21.

Download the Safety Netting 2020 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:

EMIS Safety Netting 2020 V1 Training Video - Admin

EMIS Safety Netting 2020 V1 Training Video - Clinical


EMIS Safety Netting 2020 V1 Training Guide (PDF)


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 01 October 2020 until 30 June 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

Signposting Resources

Sign posting

The 20/21 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”.Supportive information for patients on urgent referrals

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)


Cancer Care Map


Cancer Care Map is a national directory outlining local support services for cancer patients, including emotional, practical and general health and wellbeing support. The directory is:

- built on information provided by local teams

- searchable based on patient postcode and/or support need

- actively managed, with details reviewed and updated every 6 months

- freely accessible for both professionals, patients and their families/carers.