Friday 27th March 2020

What’s new with respect to 2-week-wait (2WW) referrals

  • Continue to refer patients along a 2WW pathway if you suspect cancer
  • Providers (hospitals & 2WW clinics) will conduct telephone triaging for all patients as the first step. (reduce face-to-face interaction, prioritise patients based on clinical need, and to stratify those for straight to test pathways). 
  • Providers cannot downgrade 2WW without GPs consent 
  • In some cases, where a 2WW referral is made that is not consistent with the guidelines/criteria the Provider may downgrade the referral. In these situations the Providers should be ensuring appropriate safety-netting for these patients. 

Which cancer patients are at highest risk? 

  • Anyone receiving chemotherapy, radiotherapy, immunotherapy, antibody treatments, protein kinase inhibitors or PARP inhibitors 
  • Blood or bone marrow cancers e.g leukaemia/lymphoma/myeloma at any stage of treatment
  • Anyone who has had a bone marrow or stem cell transplant in the last 6 months, or who are still taking immunosuppressive drugs  

Management of high risk cancer patients 


Steps to mitigate risk:

  • Online consultations via telephone or video wherever possible 
  • If face-to-face required encourage patients not to arrive early and consider measures such as texting when you are ready to see them, allowing them to wait in their cars
  • Cut non-essential follow ups 
  • Online ordering for regular medication as soon as possible for those at high risk, with either home or nominated delivery. 
  • Repeat prescription – ensure that where appropriate that repeat prescriptions are valid for 1 year. E.g 28 day supply with repeat dispensing set up as 12 x 28 days’ supply.

Social prescribing:

Fit notes:

  • High risk patients can use the letter they receive from NHS England as evidence to show their employer that they cannot work outside the home

Disruption to cancer services 

  • Very likely cancer services will be impacted. Providers have been instructed to prioritise treatment for those most in need. 
  • Treatment such as surgery, chemotherapy or radiotherapy may be postponed. This decision will be taken on a case by case basis by the oncology team caring for the patient. 
  • Providers should be communicating directly with patients on the impact of covid-19 on their treatment and ongoing care. 



This article was accurate as of the 27th March 2020.