Guidance for the management of Urgent Suspicion of Cancer (USC) referrals

Primary care

1. Urgent suspicion of cancer (USC) referrals from primary care should be informed by the Scottish Referral Guidelines (SRGs) for Suspected Cancer and include any additional relevant clinical information.
2. Wherever possible the referrer should inform the patient that they are being referred for investigation of a suspected cancer. The referral should clearly state whether this conversation has taken place.
3. If symptoms worsen while waiting to be seen in secondary care, primary care should reassess the patient.
4. There must be a system in place to allow the referrer to communicate concerns about a secondary care decision, as soon as possible.

Secondary care

1. Active Clinical Referral Triage (ACRT) should take place when a USC referral is first received from primary care and should be completed within 72 hours.
2. ACRT decisions should be based on evidence-based guidelines, such as the SRGs, alongside the clinical judgement of the secondary care specialist/clinician.
3. When making an ACRT decision, take account of the primary care professional’s assessment, including ‘gut instinct" or similar.
4. Job plan time should be allocated for senior clinicians to undertake ACRT to allow activity to happen in a timely manner.
5. A clear record should be maintained of all ACRT decisions. Internal audit of ACRT outcomes is recommended as good practice.
6. Referral management systems must allow:
   1. A clinical priority to be assigned to a referral.
   2. A referral to be passed to another speciality, where appropriate, without sending the patient back to primary care, to minimise delay.
   3. Referrer to be contacted to provide for further information.
7. If the ACRT outcome is discharge with advice, or there is a change in clinical priority from USC, the outcome should be communicated:
   1. To the referrer and the patient if it has been clearly stated that the patient is aware of the initial USC referral and the referral aligns to SRGs or locally agreed guidance.
   2. To the referrer, and ask them to inform the patient, if it is not stated that the patient is aware of the USC referral priority or if the referral does not align to SRGs or locally agreed guidance.
8. Any communication from secondary care to the referrer should include the name of the clinician responsible for ACRT decision-making.
9. Secondary care systems should be able to generate a letter to the referrer and patient in a timely manner.
10. Only patients on an urgent suspicion of cancer (USC) pathway should be tracked. If a USC referral is changed to routine or urgent priority, cancer tracking should be stopped and appropriate documentation updated (e.g. PTL).