Fast Track Suspected Cancer Referral Forms including Dental

Dental Fast track Suspected Cancer Referral Form

The form below can be downloaded and used as a fillable form.  A Word version of this document has been circulated out to individual practices.

Please contact the Alliance for any queries: nencicb.nca@nhs.net

Dental Fast Track Suspected Cancer Referral Form for Head and Neck Cancer

Please use these contact details for GDP suspected head and neck cancer referrals:

Contact details for GDP Suspected Head and Neck Cancer Referrals

Fast track Suspected Cancer Referral Form – Medical

The forms are in line with the NICE guidance NG12: Suspected Cancer Recognition and Referral. They have been developed to be used as integrated forms in EMIS Web and System One GP clinical systems.

The forms have been designed to optimise the clinical information in the referral to support the safe and effective care of people being referred to hospital for investigations for suspected cancer.

Most people referred to hospital in this way do not have cancer.

Please use the documents here to check you are using the most up to date Fast Track Suspected Cancer forms. All forms should be completed in the clinical system even if the form has to be emailed.

Fast Track Suspected Cancer Referral Forms & Contact Lists – Latest Version (May 2024)

1. List of contacts for each trust if the form cannot be sent on the e-referral system.
2. List of contacts for each trust for MUO referrals

3. Fast Track Suspected Cancer Referral Forms (PDFs) – For Reference Only. DO NOT LOAD THE PDF FORMS INTO ANY CLINCAL SYSTEMS. Please use the forms directly in EMIS and SystmOne following the instructions below. Complete information required before sending referrals

   1. BREAST
   2. BRAIN CNS
   3. GYNAECOLOGY
   4. HAEMATOLOGY
   5. HEAD &  NECK
   6. LUNG
   7. SARCOMA
   8. SKIN
   9. THYROID
   10. UROLOGY
   11. Malignancy of Undefined Origin
   12. UPPER GI – referrals to Gateshead/South Tyneside & Sunderland/North Cumbria
   13. LOWER GI – referrals to Gateshead/South Tyneside & Sunderland/North Cumbria
   14. COMBINED PATHWAY (UGI & LGI) – referrals to Newcastle/CDDFT/Northumbria/North Tees/South Tees
   15. Serious Non Specific Symptoms (NSS)
       • • CDDFT
         • Newcastle
         • Northumbria
         • North Tees
         • South Tees
         • North Cumbria
   16. Referral Header Sheet V4b

Non-Urgent (NOT FAST TRACK SUSPECTED CANCER) Forms

NCA Non-Urgent (not Fast Track Suspected Cancer Forms) Upper GI Endoscopy

Basal Cell Carcinoma BCC Form (Newcastle, Gateshead, Northumberland and N. Tyneside, S. Tyneside, Sunderland, Co. Durham and Darlington)

SystmOne Information
The Urgent Suspected Cancer Referral Forms are available on SystmOne via the Organisation Group, DCS. Derwentside Clinical System (DCS) is the former name of the Clinical Digital Resource Collaborative (CDRC), who are a NENC ICB clinical resource provider operating in SystmOne and EMIS.

Instructions on how to join the DCS organisation group can be found here.

Instructions on how to locate and use the Urgent Suspected Cancer Referral Forms can be found here.

EMIS Information
The Urgent Suspected Cancer Referral Forms are available on EMIS via the CDRC Precision Resource Launcher in Resource Publisher. This means that any amendments to the Urgent Suspected Cancer Referral Forms will automatically update in your system without you requiring to download, import and populate the forms in yourself.

Please follow these instructions to activate the CDRC Precision Resource Launcher and to locate the Urgent Suspected Cancer Referral Forms. If you are having difficulty with access or locating these forms, please contact contact-cdrc@healthinnovationnenc.org.uk

Access Fast Track Suspected Cancer Referral – Patient Information Leaflets here