NICE (NG12) Suspected Cancer: Recognition & Referral guidelines

Follow national guidelines where appropriate, whilst also using your own clinical judgment or gut feeling. Use tools to support you in following the guidelines like our NICE NG12 interactive symptoms guide(PDF, 1.18 MB). Be aware of local guidelines whilst using the tools.

Use Advice and Guidance services to inform decision-making if referral guideline criteria is not met and you are uncertain of the most appropriate next steps.

Use primary care investigations where available at point of care to aid decision-making prior to referral. Check which investigations are recommended in referral guidelines to help prioritise. Chest X-rays, CT scans and blood tests are usually accessible and may help support clinical assessment. If you’re unsure of what’s available to you, contact your practice, ICS or Health Board.

Explain to patients that they are being referred on a suspected cancer pathway. Ask your patient if they have any questions. Let them know what to expect at their next appointment and communicate the importance of attending. You can use our Your Suspected Cancer Referral Explained resource to support conversations.

For patients presenting with non-specific symptoms, check the availability of non-specific symptom pathways i.e. Rapid Diagnostic Centres (RDCs) in your local area. See our non-specific symptoms webpage for guidance on the referral pathways in each UK nation, and some top tips for managing these patients effectively.

Implement robust and consistent safety netting to help manage diagnostic uncertainty. Safety netting is vital for all patients, including those who’ve been referred to secondary care. For those who are managed in primary care, continue to support or investigate until symptoms are explained or resolved. Ensure safety netting systems are set up, actions are recorded and referrals are coded appropriately. Remember to act on clinical suspicion or ‘gut feeling’ if you still have concerns.