The Paediatrics 2WW Pathway that is speeding up cancer diagnoses and avoiding unnecessary hospital visits

In 2021, the Children’s Cancer and Leukaemia Group (CCLG) published new referral guidelines for suspected cancer in children and young people. These guidelines state that if primary care identify a very high suspicion of malignancy for patients, a referral should be immediate and by telephone. Consultant Connect’s Advice & Guidance service has been commissioned in Coventry and Warwickshire ICB since 2016, providing rapid access to specialist opinions across the local area but not used for the 2WW pathway.

The existing route for primary care clinicians to contact secondary care when seeing children with suspected cancer was to call the hospital switchboard and ask to be put through to a specialist’s bleep or their personal assistant. This method was time-consuming and convoluted for already busy primary care practitioners, and often meant they would have to wait indefinitely for a callback. 

 To meet and combine seamlessly with the new guidance, in November 2021, UHCW set up and launched a new ground-breaking Paediatric 2WW Pathway via Consultant Connect. The service launched within two weeks and comprises a telephone and messaging line used concurrently, allowing clinicians in primary care to call specialists at the touch of a button and then follow up with a message, attaching clinical images, reports and/or documents if an urgent referral is advised. Queries are monitored by a rota of local consultant paediatricians and cancer specialists, with backup provided by acute general paediatricians as needed, fitting in with clinicians’ existing schedules. The pathway bypasses the hospital switchboard and has dramatically sped up cancer diagnoses for children and young people, fast-tracking patients with concerning symptoms for specialist treatment.

‘Providing advice via Consultant Connect means we’re connected with clinical colleagues immediately. I can gather additional information that enables clearer decision-making about whether the child needs to be seen the same day in ED, or as soon as possible in an outpatient clinic, or even that they don’t need to be seen in secondary care and we can advise other investigations or a “watchful waiting” approach. The messaging function means that contextual data, such as diagnostic results, can be securely shared and further communication can continue between the clinician and consultant involved.’

– Dr Kim Neuling, Consultant Paediatrician at UHCW.

Dr Lucy O’Flanagan, a GP in Coventry who has used the pathway, comments:

‘The service gives us instant responses to our questions from specialist consultants, and it saves us time. This pathway improves patient care and is much more efficient. I saw a teenage patient with a firm lump arising from his chest wall costal margin area. I called the Paediatric 2WW Pathway and spoke to Dr Neuling, who saw the patient within two days of making the call. The communication allowed for better patient care and the process of requesting an appointment was much quicker to action via Consultant Connect, and I could easily see the outcome of the referral.’

‘The new pathway speeds up the referral process and means, together with primary care, we can reduce unnecessary hospital visits and anxiety for families of well children. In addition, it allows us to share the responsibility of the “watchful waiting” process with primary care colleagues. I can discuss other likely causes of an abnormality so that the clinician can update the family prior to an appointment. This helps my communication with families as they are then already prepared for the likely outcome.’

– Dr Neuling.

‘Having that knowledge that you can immediately speak with a consultant to get a sense-check and deliver feedback to the patient and their family at the same time is invaluable. It’s like a safety net.’

– Dr Hazel Blanchard, GP Partner in Coventry.

In the last 12 months*:

• The Paediatric 2WW Pathway telephone line has received 257 calls, with an 84% first-time connection rate. Calls were answered within 18 seconds on average.
• 41% of all calls resulted in the patient avoiding an unnecessary 2WW referral, allowing them to be cared for within the community and alleviating any anxiety.
• 22% of calls resulted in the patient requiring a 2WW referral, which the clinicians were then directed to send via the Paediatric 2WW Pathway messaging line. On average, messages sent following a referral being advised were responded to within 24 minutes, ensuring patients with sinister symptoms received rapid and enhanced care.
• An additional 13% of calls resulted in the patient being advised to attend the children’s ED (CED), bypassing a referral to receive an expedited level of care.
• The remaining 24% of calls required more information or a diagnostic before patient management plans could be advised.

Routing this service via Consultant Connect provides a standardised single point of access for healthcare professionals, simplifying and speeding up the process of speaking with consultant colleagues. Designed to fit in with specialists’ existing schedules, queries go through a rota. This means specialists can answer calls when available, and clinicians can ring, safe in the knowledge that their inquiry will be answered quickly. Additionally, all activity is recorded for medico-legal purposes, allowing clinicians involved in an interaction to retrospectively download their call recordings and export messages as secure PDFs. The figures are also collated by UHCW’s Consultant Connect Account Manager to create data-rich reports, giving the specialist team insight into the number of queries received and how the patient’s journey has proceeded.

* Data from 1st November 2023 – 1st November 2024. All percentages are based on reported outcomes.