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Introduction National guidance mandates urgent specialist referral for suspected brain and CNS (central nervous system) cancer cases, with target for assessment within 14 days. 1, 2 Referrals are actively tracked on a cancer tracking system with patients highlighted who are about to breach the 14 day target. Knowledge about the effectiveness of such red flag referral pathways to neurology is lacking in Northern Ireland.Methods A retrospective audit was conducted looking at red flag referrals to neurology in a single health trust in Northern Ireland over 5 years (the Western Health and Social Care Trust). A simultaneous retrospective audit of incidental CNS oncology cases over the same time period was also performed in the same Trust.Results Over 5 years from January 2016-December 2020, there were 399 red flag referrals to neurology. 6 patients (1.5%) went on to have a new brain/CNS neoplasm diagnosis, with 50% of these 6 presenting to the emergency department (ED) and being diagnosed prior to neurology review. Of the 145 CNS oncology cases over this 5 year period, 77%, (112 of 145) of cases presented via the emergency department/acute stroke pathways.Conclusions Red flag neurology referrals have very small probability of detecting brain/CNS cancer. Actual brain cancer cases typically require emergency admission for work up. Guidelines for primary care referrals for suspected neuro-oncology require revision in light of poor performance of promoted pathwaysMarymccullagh93@gmail.com