Fast Track Suspected Cancer Referral Forms

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: england.nca@nhs.net

Dental Fast Track Suspected Cancer Referral Form for Oral Surgery

Contact details for submitting Fast Track Suspected Cancer Referral Forms

Information on the Latest Release of the NCA regional Fast Track Suspected Cancer Referral Forms – Jan 2020

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 2023)

  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. UROLOGYupdate in progress
    11. Malignancy of Undefined Originupdate in progress
    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)
    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)

EMIS Information

EMIS Fast Track Suspected Cancer Referral Forms forms are now all available on resource publisher. This means that any updates will complete automatically without having to reload the forms in your system.

Please follow these instructions to activate resource publisher. If you are having difficulty using resource publisher please use the contact email in the document.

Accessing EMIS Resource Pubilsher for up to date Fast Track Suspected Cancer forms

If you need EMIS forms in the old format in a zipped folder please contact england.nca@nhs.net

Instructions for use of the forms in EMIS web are available here.

SystmOne Information
  1. DCS system Introductions and DCS Organisation Group Instructions on how to access forms in SystmOne format.
  2. Instructions for use of the forms in SystmOne

Access Fast Track Suspected Cancer Referral – Patient Information Leaflets here