Aims In the UK, USC/2WW referrals are referrals from primary care to secondary care with a dedicated timeframe for every stage of the patient pathway, which acts as national standards and key measures of performance. USC/2WW referrals are managed differently in each individual units due to various factors including time pressure, clinical expertise and infrastructure. Methodology A retrospective observational study was performed to look at the various outcomes of the USC referrals in the department. All the information were retrieved from the electronic patient record system. Results 199 referrals were included over a period of 3 months. 138 (69.3%) of the referrals were seen by the HN team (HN). 12 (0.06%) were positive for malignancy, The average number of days from appointment to diagnosis for the malignancy cohort was 23.6 days for HN and 47.5 days for non-HN. 58 (29.1%) patients seen by HN were discharged on first visit compared to 36 (18%) by non HN (Fisher exact test value is 0.0315, P < 0.05). 79 (39.7%) patients seen by HN were removed from USC pathway on first visit compared to 42 (21.1%) (Fisher exact test value is 0.1563, P > 0.05). Less investigations were requested by the HN (14%) compared to non-HN (11.6%) The Fisher exact test value is 0.0133, P < 0.05). Conclusion In many units, USC/2WW referrals are distributed equally amongst the clinician due to the target of achieving first appointment with a “specialist” within a maximum of 14 days of referral. As a result, these “specialists” may not necessarily be head and neck surgeons, rendering delays in diagnosis and treatment and requesting unnecessary investigations and procedures. The preliminary date from this study supported this hypothesis. A collaborative study with a bigger sample size is needed to further test this hypothesis to ensure a more streamlined patient journey.