Breast (symptomatic) referrals - NHS e-Referral Service

The requirement for all breast referrals to be seen within two weeks takes these referrals outside the current free choice policy, as they now fall into the urgent care category of referrals.

However, this does not mean that choice should not be offered to patients and a reduction in waiting time should not automatically exclude the offer of choice of provider. This is not in any way ‘downgrading’ choice in breast referrals but ensuring that nothing stands in the way of confirming suspected breast cancer.

Currently, two week wait (2WW) suspected cancer services may be on either menu on the NHS e-Referral Service (e-RS). Where providers are happy to accept referrals from out of their immediate area, they should continue to make these services available on the secondary care menu. The 'non suspected cancer' breast referrals were previously on the secondary care menu, but the change in referral priority means that these services may now be listed on the primary care menu.

Because the cancer monitoring data set requires providers to record and report the priority type of 2WW for all patients referred for either suspected cancer or symptomatic breast problems, service definers need to ensure that their directory of service (DoS) entries are set to accept 2WW priority referrals.

The clinic type names available under the specialty ‘Surgery – Breast’ are as follows:

• FH of breast cancer (non 2WW)
• Mammoplasty (non 2WW)
• Oncology established diagnosis (non 2WW)
• Other symptomatic breast (2WW)

The slot poll range for all 2WW priority services should be set in accordance with the maximum waiting time for referrals with suspected cancer.  To allow patients to be booked into same-day slots, ensure ‘today’ is counted as day 1 when calculating the polling range for 2ww services, to minimising the chance of a breach. You may wish to consider having separate services defined on e-RS to cover the above clinic types, even if they will all map to the same clinic on your patient administration system (PAS). This will allow both for differing polling ranges, depending on whether they fall within the 2WW requirement, and will aid reporting. If, in agreement with your Local Commissioning Organisation, you have decided to make your breast symptomatic 2WW services available locally, please ensure that the Local Commissioning Organisation has commissioned these services on e-RS. If however you choose to put these services on the secondary care menu they will be visible to all referrers in e-RS.

Referrers need to ensure that the priority type of 2WW is selected for all symptomatic breast referrals. As with 2WW referrals for suspected cancer, it is important that the referral information is attached to e-RS within one working day.

Practices should ensure that the same process is followed as for 2WW suspected cancer patients and that patients should wherever possible book their outpatient appointment before leaving the practice. Practices should monitor worklists and run the ‘Two Week Wait’ enquiry on a daily basis to monitor and follow up patients who may not have booked their appointment.