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Views of general practitioners and head and neck surgeons on the referral system for suspected cancer: a survey

  • G S Bethell (a1) and P Leftwick (a1)

The two-week wait referral system for suspected cancer was introduced in the National Health Service in 2000. This study aimed to identify areas for improvement to the two-week wait system by seeking the opinions of doctors working in primary and secondary care.


A questionnaire was distributed to general practitioners and head and neck surgeons within North West England with ethical consent.


Twenty-seven general practitioners and 15 head and neck surgeons responded. Of the general practitioners, 59.3 per cent declared that they never attend training on referrals in this specialty. Overall, 59.3 per cent of general practitioners and 86.7 per cent of head and neck surgeons felt that the two-week wait system could be improved.


The main areas for further work are development of pre-referral communication between primary and secondary care along with development of practical educational measures for general practitioners.

Corresponding author
Address for correspondence: Mr George Bethell, Community Studies Unit, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, UK E-mail:
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Presented at the Society for Academic Primary Care North meeting, 21 November 2013, Kendal, UK.

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1Jones, R, Rubin, G, Hungin, P. Is the two week rule for cancer referrals working? BMJ 2001;322:1555–6
2Ndukwe, N, Borowski, DW, Lee, A, Orr, A, Dexter-Smith, S, Agarwal, AK. The two-week rule for suspected colorectal cancer: patient experience and psychological impact. Int J Health Care Qual Assur 2012;25:7585
3National Cancer Intelligence Network. Urgent GP referral rates for suspected cancer. In: [5 March 2014]
4McKie, C, Ahmad, UA, Fellows, S, Meikle, D, Stafford, FW, Thomson, PJ et al. The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance. Oral Oncol 2008;44:851–6
5Potter, S, Govindarajulu, S, Shere, M, Braddon, F, Curran, G, Greenwood, R et al. Referral patterns, cancer diagnoses, and waiting times after introduction of two week wait rule for breast cancer: prospective cohort study. BMJ 2007;335:288
6McCain, S, Newell, J, Badger, S, Kennedy, R, Kirk, S. Referral patterns, clinical examination and the two-week-rule for breast cancer: a cohort study. Ulster Med J 2011;80:6871
7Smith, RA, Oshin, O, McCallum, J, Randles, J, Kennedy, S, Delamere, S et al. Outcomes in 2748 patients referred to a colorectal two-week rule clinic. Colorectal Dis 2007;9:340–3
8Cox, NH. Evaluation of the U.K. 2-week referral rule for skin cancer. Br J Dermatol 2004;150:291–8
9Duvvi, SK, Thomas, L, Vijayanand, S, Reddy, KT. Two-week rule for suspected head and neck cancer. A study of compliance and effectiveness. J Eval Clin Pract 2006;12:591–4
10Lyons, M, Philpott, J, Hore, I, Watters, G. Audit of referrals for head and neck cancer - the effect of the 2-week, fast track referral system. Clin Otolaryngol Allied Sci 2004;29:143–5
11Blick, C, Bailey, D, Haldar, N, Bdesha, A, Kelleher, J, Muneer, A. The impact of the two-week wait rule on the diagnosis and management of bladder cancer in a single UK institution. Ann R Coll Surg Engl 2010;92:4650
12Mansell, G, Shapley, M, Jordan, JL, Jordan, K. Interventions to reduce primary care delay in cancer referral: a systematic review. Br J Gen Pract 2011;61:821–35
13Shariff, Z, Roshan, A, Williams, AM, Platt, AJ. 2-Week wait referrals in suspected skin cancer: does an instructional module for general practitioners improve diagnostic accuracy? Surgeon 2010;8:247–51
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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