HI,
I’m after pathways descriptions around this (we are a bit lite on BA’s). Does anyone know of a source for these.
This is to explain the process to managers and developers like me (so maybe really simple 
).
Of particular interest is where the order and reports go (who needs what), maybe how these all feed into a MDT. Ideally this incudes genomic testing (I think this is where it is complex).
o.s. not that interested in computer systems, more interactions between people.
Thanks in advance.
Something like this https://gettingitrightfirsttime.co.uk/wp-content/uploads/2024/03/BestPracticeTimedDiagnosticCancerPathwayssummary-guide-March-24-V3.pdf ?
Thank you.
I’ve used that with AI to create a use case.
The timelines seem a bit short (a relative went through this pathway recently but I think most of this happend).
BUT it’s got some key reasons for sharing genomic reports more widely - which is what I was after.
Use Case: Colorectal Diagnostic Pathway (Derby → Nottingham University Hospitals NHS Trust → North West Genomics)
🧑⚕️ Patient Profile
Name: Mr. Kumar (example)
Location: Derby, UK
Age: 62
Symptoms: Persistent change in bowel habits, intermittent rectal bleeding, unexplained weight loss
GP Registered With: Derby GP Practice
Referring NHS Trust: Derbyshire (primary care)
Receiving NHS Trust: Nottingham University Hospitals NHS Trust (NUH)
Genomics Laboratory Hub (GLH): North West Genomics for any advanced molecular/genomic testing
🧭 Step-by-Step Pathway in Line with Best Practice Timed Diagnostic Guidance
(Based on the 28-day Faster Diagnosis Standard and best practice principles summarised in the GIRFT 2024 guide.)
Day 0 — GP Referral (Urgent Suspected Cancer)
Mr. Kumar visits his GP in Derby with symptoms matching NG12 suspected colorectal cancer criteria (weight loss, bleeding, change in bowel habits).
GP performs initial assessments including FIT (Faecal Immunochemical Test) and basic blood tests (FBC, iron studies).
Based on high-risk FIT results, the GP makes an urgent suspected cancer referral to Nottingham University Hospitals NHS Trust via e-Referral Service (eRS).
Referral includes minimum dataset: symptoms, FIT result, bloods, family history, medications, performance status, and communication preferences.
Goal: Enable straight to test routing where possible.
Day 1–7 — Triage & Navigation
NUH cancer services receive the referral and initiate clinical triage within 7 days:
Review of referral data by a clinical nurse specialist (CNS) and colorectal team.
Determine the most appropriate diagnostic route (e.g., colonoscopy, CT colonography, flexible sigmoidoscopy).
A cancer navigator is assigned to coordinate all appointments, track progress, and communicate with the patient.
Goal: Efficient prioritisation and sequencing to support rapid diagnostics and minimise wasted clinic waits.
Day 7–14 — Diagnostic Testing
Mr. Kumar is scheduled for:
Colonoscopy (primary definitive test)
CT colonography if incomplete colonoscopy or contraindications
Parallel pathology work (e.g., biopsy testing) is initiated if suspicious lesions are found.
Test reports are expedited back to the colorectal MDT and referring clinician.
Goal: Complete key diagnostic investigations early in pathway to support 28-day standard.
Day 14–21 — Multidisciplinary Team (MDT) Review
If cancer is confirmed on biopsy, NUH MDT review diagnosis, stage, and immediate next steps.
Genomic profiling may be indicated (e.g., if advanced disease or targeted therapy considerations). Here, North West Genomics GLH receives tumour samples or sequencing requests for actionable genomic tests.
Example work: mismatch repair (MMR) status, RAS/BRAF profiling (if colorectal cancer confirmed) as per clinical indications.
Genomics results are expected shortly after initial pathology to inform precision treatment planning.
Goal: Early integration of genomics into treatment planning where indicated.
Day 21–28 — Communication & Decision to Treat
The diagnosis (cancer confirmed or ruled out) is communicated to Mr. Kumar within 28 days of referral — meeting the Faster Diagnosis Standard.
If cancer: a decision to treat is made, and care planning begins (surgical referral, oncology, or multidisciplinary care).
If no cancer: Mr. Kumar receives a non-cancer diagnosis and appropriate routing back to primary care or symptomatic management.
💡 Outcomes & Benefits of Following the Best Practice Timed Pathway
✔ Reduces waiting time from referral to diagnosis to within 28 days.
✔ Prioritises high-risk patients for early, appropriate diagnostics (e.g., straight to test).
✔ Supports coordinated care across primary care, secondary care, MDT, and genomics services.
✔ Improves patient experience with earlier communication and streamlined navigation.
✔ Aligns with national quality standards and GIRFT-endorsed best practice.