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REMEDY : BNSSG referral pathways & Joint Formulary

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Non-Specific Symptoms - USC (2WW) - suspended

Checked: 12-11-2023 by 3 Vicky Ryan Next Review: 12-06-2024

Service overview

****STOP PRESS 22.12.23*******.

The NSS service hosted by BHOC is currently closed for new referrals. Significant staff shortages within the NSS team have meant that new referrals cannot be safely managed by the service at the current time. Reopening the service is a system priority as it is acknowledged that the alternative pathways for managing these patients are suboptimal. Please use GP direct access diagnostics and alternative referral pathways until the service is reopened.******************

The Non Specific Symptom Pathway Pilot went live in Spring 2022. This is for patients with “vague symptoms” who do not meet the criteria for the existing suspected cancer pathways.

It is well recognised that there are a cohort of patients with symptoms that indicate they have a significant chance of having cancer but until now there has been no 2WW pathway to arrange investigation and assessment in a timely manner. 

The BNSSG Non-Specific Symptoms (NSS) is a new cancer referral pathway for patients in whom there is concern about cancer, but whose symptoms do not fit other site-specific NG12 (fast track) referral criteria.

The NSS service is based at the Bristol Haematology and Oncology centre but is working in partnership with primary care and the acute trusts in BNSSG to provide timely access to appropriate investigations to assess patients with concerning non-specific symptoms. These investigations will, whenever possible, take place in a hospital local to the patient.

Patients with evidence of metastatic cancer without a known primary should continue to be referred to the Cancer of Unknown Primary service.

Referral criteria and the mandatory filter tests

The referral criteria are not an exhaustive list and many patients will have symptoms that tick several of these boxes. Patients should only be referred to the NSS if there is no other urgent referral pathway suitable for their clinical scenario.

Patients with unexplained laboratory test findings should be referred to the relevant speciality (eg Haematology advice and guidance) unless there are other symptoms which increase the level of concern. If advice and guidance is sought prior to referral please can this be included with the referral.

  • Unexplained weight loss
  • Patient reports severe unexplained fatigue
  • Persistent nausea or appetite loss
  • New atypical pain (eg. diffuse abdominal pain or bone pain)
  • Unexplained laboratory test findings (eg. anaemia, thrombocytosis, hypercalcemia)
  • Ongoing symptoms despite one negative 2ww referral

Please see the referral form for the Filter Function test results which are required before referral, as these may suggest another diagnosis/referral pathway.

Please do not  request CT/further imaging before referral.

The NSS service has priority slots with radiology for diagnostic tests which primary care requested diagnostics are logistically difficult to move into.

Referral guidance

Refer via eRS to UHBW using the referral for Non-specific symptoms 2WW referral form

Please note, investigations will, whenever possible, take place in a hospital local to the patient.

The completed referral proforma must contain the results of all the mandatory filter tests, and a detailed reason for referral. It is vital that the filter tests are recent (less than three months old) and that the results have been reviewed prior to referral as these may demonstrate an alternative and more appropriate onward referral route.

The filter tests have been agreed by the BNSSG NSS working group and are based on nationally advised NSS filter tests.

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.