Referral Guidance
All Referrals
Urgent Suspected Cancer Referral Forms
We have a suite of suspected cancer referral forms that are agreed by Wessex Clinical Reference Groups, including primary and secondary care. All the forms are reviewed regularly to ensure they are up to date with the latest guidance.
Private Primary Care Healthcare Providers
We support onward referral by the clinician who identifies symptoms or cancer in line with NG12 Guidance, without referral back to the patient’s GP. Information for private providers in Wessex includes contact details for each Trust where the provider does not have access to e-RS.
Patient Information
It is important to provide your patient with information explaining their suspected cancer referral and next steps. Cancer Matters Wessex has a dedicated Fast Track Referrals page that includes referral information for patients that can be printed off and converted into other languages. An easy read version of the information is also available and a video in British Sign Language.
Cancer Research UK have also developed a patient leaflet that can be shared or printed: Your urgent suspected cancer referral PDF
NG12 are national guidelines developed to support primary care in the recognition and referral of suspected cancer. Use of the guidelines in primary care helps ensure people are referred along the right route, at the right time, supporting timelier and earlier cancer diagnosis.
CCLG referral guidance for suspected cancer in children and young people is a supporting resource for NICE guideline NG12. This guidance aims to ensure the recommendations in NG12 are applied effectively to children and young people, acknowledging the distinct characteristics of childhood cancers including presentation, referral pathways and care.
NG12 Summaries and Infographics
- Cancer Research UK Interactive Symptoms Guide and Suspected Cancer Referral Interactive Body Guide
- Gateway C Cancer Maps Interactive Referral Algorithm
We are adding the Rockwood Clinical Frailty Scale (CFS) to all suspected cancer referral forms from August 2025.
Why? The CFS is more sensitive in highlighting physical and cognitive changes that may affect overall outcomes in people especially over the age of 65.
Identifying frailty status can trigger discussion at the point of referral about ability to cope with investigations and treatments. Once reaching oncology services the CFS score will enable clinicians to triage patients more effectively and prompt further assessment and management of this group.
Full details about this change and CFS tutorials are available here
Pathway Specific Guidance
NICE Guidance recommends that FIT should be used to guide referral on a colorectal suspected cancer pathway and symptomatic patients should be referred if they have a FIT result of at least 10 µg Hb/g (NG12 Suspected Cancer Referral Guidance and Diagnostics Guidance DG56). By embedding FIT into the pathway the highest priority patients can be investigated more quickly and patients with a very low risk of colorectal cancer can be reassured and spared from having unnecessary invasive investigations.
FIT <10
Patients with a FIT result <10 should be safety netted in primary care with clinical review and repeat testing as appropriate. See the Wessex LGI Decision Support Flowchart for details.
The risk of colorectal cancer in those with a FIT<10 result, normal exam and full blood count is <0.1%, lower than the general population risk (Monahan et al, 2022).
Consider other cancer pathways or non-specific symptoms pathway (RIS) if cancer is still suspected.
Repeat FITs
Research has shown that patients with two FIT<10 results have a colorectal cancer risk of <0.04% (Hunt et al, 2021).
A repeat FIT can provide additional reassurance if symptoms persist, or if re-evaluation is indicated.
For full details of the Wessex LGI pathway and support available please see our dedicated Symptomatic FIT page.
We have developed a consensus statement on PSA testing for prostate cancer to provide guidance for primary care clinicians. This document contains advice for testing in men both with and without symptoms, as well as elderly and transgender women.
To accompany the statement Dr Jenny Rattray (GP Advisor) recorded a brief podcast with Wessex LMC
You can also access the Wessex Cancer Alliance and Wessex LMC webinar on urological cancer for education on prostate cancer as well as kidney and bladder cancer.
Please see our Cancer Matters Wessex page for information and resources that can be shared with patients to inform their decision making on PSA testing.
Teledermatology refers to the use of static digital images to triage, diagnose, monitor or assess skin conditions without the patient being physically present.
Visit our dedicated teledermatology page for support and guidance about how to take and upload photos, and for information about upcoming training.
Breast pain, also known as mastalgia, is a common breast symptom affecting up to 70% women at some point in their lifetime. Breast pain accounts for 20-30% of all secondary breast care referrals but isolated breast pain is rarely a sign for breast cancer.
It can however impact quality of life and provoke substantial anxiety, and lead to unnecessary investigations if not appropriately assessed.
Please watch this webinar about breast pain with Dr Christine Glew, GP Advisor for Wessex Cancer Alliance:
For further details including evidence and management strategies see our breast pain referral guidance
DORSET ONLY – If referring to UHD or DCH, a direct access ultrasound pathway is available for unscheduled bleeding on systemic HRT. Please consider this pathway via ICE for women experiencing unscheduled bleeding beyond six months of commencing HRT despite modifying progesterone intake, or where there is a concern about the clinical presentation or bleeding amount/pattern.
Please note that scanning is not recommended within the first six months of taking HRT. Please consider using Advice and Guidance route if additional support is required. For more information see our pathway FAQs
HAMPSHIRE & ISLE OF WIGHT – Rollout of this pathway in HIOW is currently underway and guidance will be updated in due course. In the meantime, the British Menopause Society guidance on the management of patients with unscheduled bleeding on HRT can be found here: Management of unscheduled bleeding on hormone replacement therapy (HRT) – British Menopause Society
The RIS provides a fast track referral pathway for adult patients in whom there is concern about cancer, but who do not fit other site-specific NG12 referral criteria. The RIS operates virtually and organises any required diagnostic tests to be performed at the provider Trust most local to the patient.
The RIS team have capacity to take more referrals and they are always happy to answer any questions regarding a new or existing patient.
Contact them via email: Wessexrds.admin@nhs.net or Phone: 0300 123 1385
Please see the Rapid Investigation Service page for more details.
