The Referral Process

The Referral Process

If an abnormal area has been identified in the oral cavity, a biopsy is the only way to know for certain whether or not it is malignant. This should be done in a specialist unit with some degree of urgency to allow early commencement of treatment, or to alleviate concern.

In the first instance, telephone contact may be made with the regional consultant in oral & maxillofacial surgery, plastic surgery, ENT surgery or oral medicine. Telephone discussion will allow the referring practitioner to identify whether or not a particular consultant deals with suspected oral cancer. This will save days, weeks or even months of unnecessary waiting.

Telephone contact should be followed-up with a formal letter of referral. The referral letter should be clearly marked 'URGENT' and addressed personally to the named consultant. Essential details which must be included in a referral letter are as follows:

  • Name, address, postcode and telephone number of patient.
  • Date of birth.
  • Name of general medical practitioner and, where appropriate, general
    dental practitioner.
  • Relevant medical and social history, including smoking and drinking status.
  • Detailed relevant history of presenting complaint with the reason for referral.
  • Clear statement of clinical findings.
  • The patient's level of understanding and concerns about his or her
    mucosal abnormality.

Community pharmacists are often the first health professionals approached by the public, and increasingly are being recognised as having key public health roles within the primary health care team and communities. They are an important gateway to the NHS and their pivotal position could be harnessed for the early detection of oral cancer through locally arranged referral systems. This could involve a letter of referral to a dental or medical practitioner.

For such systems to be effective, multidisciplinary health care professional networks need to be established to allow the patient journey to be smooth and efficient. This could be promoted through joint training and audit initiatives. At a locality area level, an example of such working could ensure that pharmacists are made aware of those general dental practitioners currently accepting NHS patients on to their list.