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Delays are described in the diagnosis of Amyotrophic Lateral Sclerosis (ALS) even in studies based in tertiary hospitals, with median time of 15 months. This audit aims to evaluate timelines and milestones in the diagnosis of ALS in a UK District General Hospital (DGH).Dates of the main diagnostic milestones were audited in 43 patients diagnosed with ALS, attending the Motor Neuron Disease clinic of the Neurology Department of the Great Western Hospital Foundation Trust, Swindon, between June 2023 and June 2024. Data was collected from patients’ clinical records.The median time between symptoms-onset and first medical contact was 4.5 months (IQR: 2-11.5). 29% of patients were seen by two or more specialists before neurology referral. Sources of neurology referral included GP (57.5%), A&E (12.5%), orthopedic surgeons (10%) and others, including SaLT, physiotherapists and neurophysiologists (20%). Overall, median symptom-to-diagnosis interval was 15 months (IQR: 8.5-35.5), with no significant difference between gender or age groups.Diagnostic time of ALS in a DGH is long, but consistent with delays reported in the literature. The majority of patients are referred for specialist neurology assessment by GPs, suggesting that educational initiatives targeted to the community could reduce this delay.jiwoo.sohn@kcl.ac.uk