Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Non-Specific Symptoms - 2WW

Checked: 22-06-2022 by vicky.ryan Next Review: 21-06-2023

Service overview

The Non Specific Symptom Pathway Pilot went live in Spring 2022. This is for patients with “vague symptoms” who do not meet the criteria for the existing suspected cancer pathways.

It is well recognised that there are a cohort of patients with symptoms that indicate they have a significant chance of having cancer but until now there has been no 2WW pathway to arrange investigation and assessment in a timely manner. 

The BNSSG Non-Specific Symptoms (NSS) is a new cancer referral pathway for patients in whom there is concern about cancer, but whose symptoms do not fit other site-specific NG12 (fast track) referral criteria.

The NSS service is based at the Bristol Haematology and Oncology centre but is working in partnership with primary care and the acute trusts in BNSSG to provide timely access to appropriate investigations to assess patients with concerning non-specific symptoms. These investigations will, whenever possible, take place in a hospital local to the patient.

Patients with evidence of metastatic cancer without a known primary should continue to be referred to the Cancer of Unknown Primary service.

Referral criteria and the mandatory filter tests

The referral criteria are not an exhaustive list and many patients will have symptoms that tick several of these boxes. Patients should only be referred to the NSS if there is no other urgent referral pathway suitable for their clinical scenario.

Patients with unexplained laboratory test findings should be referred to the relevant speciality (eg Haematology advice and guidance) unless there are other symptoms which increase the level of concern. If advice and guidance is sought prior to referral please can this be included with the referral.

  • Unexplained weight loss
  • Patient reports severe unexplained fatigue
  • Persistent nausea or appetite loss
  • New atypical pain (eg. diffuse abdominal pain or bone pain)
  • Unexplained laboratory test findings (eg. anaemia, thrombocytosis, hypercalcemia)
  • Ongoing symptoms despite one negative 2ww referral

Please see the referral form for the Filter Function test results which are required before referral, as these may suggest another diagnosis/referral pathway.

Referral guidance

Refer via eRS to UHBW using the referral for Non-specific symptoms 2WW referral form

Please note, investigations will, whenever possible, take place in a hospital local to the patient.

The completed referral proforma must contain the results of all the mandatory filter tests, and a detailed reason for referral. It is vital that the filter tests are recent (less than six months old) and that the results have been reviewed prior to referral as these may demonstrate an alternative and more appropriate onward referral route.

The filter tests have been agreed by the BNSSG NSS working group and are based on nationally mandate NSS filter tests.