References
Setting up a nurse-led 2-week-wait head and neck cancer diagnostic service
Abstract
The number of urgent ‘2-week-wait’ referrals to hospital for people with suspected head and neck cancer being sent by primary care is constantly growing and it is becoming increasingly difficult for head and neck cancer services to meet this demand. In order for trusts to meet their Faster Diagnosis Standards, there needs to be an effective and efficient way to ensure there is capacity for patients to receive the appropriate assessments and diagnostic investigations without compromising the quality of care delivered. This article presents the proposal of introducing a nurse-led 2-week-wait clinic to meet the ever-growing demands on the service. There is discussion of the consultant-led training programme used to upskill an advanced nurse practitioner in a single-centre study, as well as explanation of the processes followed to maintain patient safety throughout the pilot project. There will also be consideration of clinical governance and discussion of how patient satisfaction with the novel service will be measured.
Head and neck cancer is the fourth most common referral made by primary care, namely GPs and dentists, comprising 9% of all referrals for suspected cancer in England (NHS England, 2023a). Each year in the UK there are around 12800 cases of head and neck cancer diagnosed (2017–19 figures) and this is projected to increase by a further 3% between 2023–25 and 2038–40 (Cancer Research UK, 2024). At present, the majority of patients being initiated on the diagnostic pathway for head and neck cancer are via the national ‘2-week-wait’ referral, which requires the surgical head and neck cancer team in specialist tertiary centres to review and assess patients. GPs and dentists refer patients with ‘red flag’ symptoms such as unilateral throat pain, a persistent hoarse voice and non-healing mouth lesions. The number of referrals sent for suspected head and neck cancer across England has increased over recent years. The latest figure for 2022–23 was 275354 referrals (NHS England, 2024). When considering this significant increase in referrals, along with a national conversion rate of 2.6% from referral to diagnosis (NHS England, 2024), it is evident that alternative solutions need to be explored within already stretched head and neck cancer services to safely meet this growing demand and the volume of patients requiring assessment for suspected head and neck cancer.
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