Medical oncology is primarily a tertiary referral service. Only a few patients are referred directly from primary care or via a 2-week wait service (see the Department of Health’s The NHS cancer plan: a plan for investment, a plan for reform (opens PDF, 350.01KB)) as a histological diagnosis is generally required prior to cancer treatment planning. General surgeons and physicians undertake this diagnostic process prior to referral for treatment.

Fig 1 shows the routes that patients can take to access a medical oncologist. The size of each circle reflects the proportion of patients referred by each route.