North London Partners in health and care

Suspected Cancer referrals during the COVID-19 Pandemic

Covid-19 is a national emergency and is severely reducing the capacity for the NHS to diagnose and treat cancer.  NHS England is issuing guidance to provider trusts and primary care, setting out changes to pathways in the light of reduced capacity.  We all recognize the need to work differently with a more measured approach, at this difficult time.

Suspected Cancer Referrals (2ww - two week wait)

  • Some suspected cancer pathways will be modified in this period and some changes have been approved by NHSE Clinical Advisory Group (CAG) with others followings soon. The pathways subject to change are listed in section D.
  • The other suspected cancer referral pathways will continue, BUT it is important to recognise that all trusts services have been impacted and many investigations and treatments are being deferred or changed. This will continue to be under review.
  • Providers are moving towards telephone triage services as a first appointment so patients can be streamlined to a test directly and minimise interactions in the health service.
  • We encourage our GP partners to consider referrals fully, so we can all support each other in these unprecedented times. Some key areas are:
    • For lower risk patients, consider safety netting these patients using a robust method (e.g E-safety netting toolkit in EMIS Web) with a recall date for review
    • Continue and optimise good practice around referral quality by providing as much relevant clinical detail
    • Ensure pre-referral tests are completed where possible
    • Record a patient’s performance status and if they are at high risk of Covid-19 / Covid-19 category.
  •  Straight to test may not be an option in the near future on clinical grounds. All non-urgent endoscopy has stopped.

Multi Diagnostic Centre (MDC) Rapid Diagnostic Centre (RDC) 

  • The UCLH MDC site is now closed and is not accepting any new referrals.
  • The North Middlesex Hospital MDC site will also be closing as of 1 April 2020.
  • It is important that GPs identify the most appropriate suspected cancer pathway and refer down this route. Communication is central and GPs writing a coherent and detailed picture of their concerns will facilitate effective triage.

Investigations – Direct Access Diagnostics into secondary care

  • Providers have requested that Primary Care stops most (urgent and non-urgent) Direct Access Diagnostics requests, in order to prioritise their limited diagnostic capacity for the most urgent cases. We will be reviewing this and will update you.
  • Phlebotomy services in hospital are under huge pressure and will be unlikely to cope at current pressures. We will update you on the status.
  • If you have local private providers commissioned to provide direct access, please check with your CCG regarding the availability of tests in current circumstances.

 Specific Cancer pathways


  • The bowel and breast National Screening programmes have paused in the short term. No new invitations will be sent out to patients. Some patients requiring urgent follow-up may still be seen.
  • This will mean that local NCL initiatives as well as those led by NHSE and the screening services such as text reminders will also pause.
  • More information to follow.

Patient Communication

  • Formal communication leaflets are being produced by NCL STP which we hope to share with you in the near future.
  • We would encourage you to inform patients that:
    • There may be delays in their investigations/management
    • If they develop COVID symptoms after their referral they should NOT go to an appointment and let the hospital and their GP know
  • Patients will be feeling the full impact of these changes and they are likely to have many questions for you.

Further information and contact details

We encourage all practices to have robust safety netting processes in place. Example: E-Safety Netting toolkit in EMIS Web (

We also highly recommend practices record where decisions have been influenced by service circumstances during the Covid-19 pandemic. EMIS Web has now developed various Covid-19 SNOMED codes.

In response to Covid-19, NCL has developed a NCL Cancer system response framework. The framework sets out a number of groups responsible for various lines of work. ANCL Cancer in Primary Care COVID-19 Group is now in place to localise London guidelines relating to primary care, disseminate changes in clinical management to primary care and feed in views from primary care into the cancer COVID-19 response.  The group will meet remotely 3x per week and will be chaired by Dr. Afsana Bhuiya and Sharon Cavanagh from NCEL Cancer Alliance. 

Should you have any queries, please email Your query will be directed to the most appropriate party for a response.