Aims Recent pressures on NHS waiting lists, exacerbated by the COVID-19 pandemic, have necessitated development of innovative pathways to expedite investigation suspected head and neck cancer. One such pathway developed in South Wales is the biopsy of suspicious upper aerodigestive tract (UADT) lesions (tongue base, larynx, hypopharynx) via a channeled flexible nasendoscopy (FNE) system in the outpatient clinic setting, under local (LA), rather than a traditional panendoscopy under general anaesthetic (GA). Methodology Retrospective case series of all biopsies of suspected UADT cancer performed in a tertiary centre before and after the introduction of a comprehensive LA diagnostic pathway over two 24-month periods (Jan 2018 – Dec 2019 vs Aug 2022- Jul 2024). Outcomes recorded include time from decision to biopsy, proportion of cases performed under LA versus GA, percentage of subsequent conversion to GA and financial impact. Results A total of 747 patients underwent UADT biopsies over the two study periods. In 2018-19; 440 patients underwent biopsies of potential head and neck cancers, of these 19(4.3%) were undertaken under LA and 421(95.7%) under GA. The mean wait time for biopsy was 42.1 days. In 2022-24; 307 patients underwent biopsies of potential head and neck cancer, of these 93(30.3%) were under LA and 214(69.7%) were under GA. The mean wait times for biopsy were 29.3 days (LA) and 48.1 days (GA). Following the introduction of a comprehensive LA diagnostic service, there was a significant increase (p<0.0001) in patients undergoing local anaesthetic UADT biopsies. Furthermore, there was a significant decrease (p=0.0021) in wait times for patients undergoing LA biopsy. Conversion to GA was <5% and cost saving was approximately £56,000pa Conclusions The use of clinic based LA FNE biopsy for USC upper aerodigestive tract lesions is a safe, cost effective replacement for panendoscopy and reduces diagnostic time in head and neck cancer.