We adapted the 2002 Scottish Referral Guidelines for suspected squamous cell carcinoma of the head and neck (SCCHN) as a set of "alarm symptoms." These were then incorporated into a new Suspected Cancer Urgent Referral Electronically (SeCURE) system enabling immediate electronic referral from primary care to the appropriate hospital-based multi-disciplinary cancer team. All referrals made via the SeCURE system during the first year of its implementation were reviewed retrospectively. One hundred and ninety patients were urgently referred, of whom 15 (8%) were ultimately diagnosed with SCCHN. This audit demonstrated overall poor compliance with the referral guidelines. Although the electronic referral system helped for speedy clinic appointments, there was a low pick up rate of positive head and neck cancer cases. Continuing education for GPs is important and following discussion with colleagues in primary care, steps have been taken to reinforce awareness and more appropriate use of the SeCURE system.

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Background/Aims  Following the Shape of Training Report, all Rheumatology registrars commencing training from August 2017 are required to obtain dual-accreditation with General Internal Medicine (GIM). Training time increased from 4 to 5 years. Current trainees have expressed concerns regarding the lack of clarity and standardisation of the structure and duration of GIM training, and the impact on Rheumatology experience. Surveys were developed and disseminated by the British Society for Rheumatology (BSR) Trainees' Committee to explore the national GIM experience and expectations of trainees and Training Programme Directors (TPDs). Methods  Two surveys were created by trainees, with support from the BSR. Web links were emailed to all UK Rheumatology trainees and TPDs in February 2020, and remained open for three weeks. The surveys covered: Duration of dedicated rheumatology trainingDuration of 'high intensity' GIM training (defined as night shifts with at least 1 in 8 on-calls)Weekly number of GIM clinics and ward roundsGuidance provided to trainees and TPDs on the expected duration and structure of GIM training. Results  73 responses were analysed from dual-accrediting trainees across the UK. 73% of trainees expected 1.5-3 years of dedicated rheumatology training however, 12% of trainees did not expect any dedicated rheumatology years. Similarly, the expected duration of ‘high intensity’ GIM training varied widely from up to 1 year (10%) to 2.5-3 years (30%). 37% of trainees expected to do more than 3.5 years of 'high intensity' GIM training. During a ‘high intensity’ GIM year, 58% of trainees did not do any GIM clinics (some Deaneries count general rheumatology clinics towards GIM), 34% had one GIM clinic and 8% of trainees had three or more GIM clinics per week. Similarly, the number of average weekly GIM ward rounds varied from none (11%) to 3 or more (55%). Only 62% of trainees confirmed they were aware of the number and 'intensity' of GIM years required during their training. Twelve TPDs completed the survey. 72% of TPDs were able to provide specific guidance on the expected duration and structure of GIM training for ST3 applicants in 2020. Despite this, 83% of TPDs felt that further guidance is required on the length of dedicated rheumatology and GIM training. Free-text comments suggested a move away from describing GIM training as ‘low', 'medium' or 'high intensity’. Conclusion  The surveys identified a wide national variation in GIM training structure and duration, and dedicated Rheumatology training for dual-accrediting trainees. This inequality has proved concerning for many trainees. TPDs and trainees felt that further information and standardisation is needed regarding the dedicated time required in Rheumatology and GIM. The results will be discussed at the next Joint Royal College of Physician’s Board (JRCPTB) Specialty Advisory Committee meeting. Disclosure  S. Khalid: None. M. Chakravorty: None. C. Godsave: None. S. Yaqub: None. E. Davies: None. M. Rutter: None. S. Shabbir: None. E. Reilly: None.

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