Whole Genome Sequencing

Identify the appropriate test for your patient in the national genomic test directory.

The test chosen will define the test request form needed, sample requirements, the laboratory within the GLH who will complete the test, and expected turnaround times for the results.

It will also identify who can request the test and if patients should be referred to clinical genetics.

Ensure an appropriate consent conversation is held with the patient, and family where required. Complete record of discussion and test request form.

For WGS, you must ensure you have your patient’s consent for their genomic testing before you send the sample to the GLH for testing. The discussion with the patient must take place according to the Consent and Confidentiality in Genomic Medicine guidelines. Training has been developed to support the Patient Choice Consent Framework in WGS which is available online and more information can be found on our consent page.

Patient information leaflets (for cancer and rare disease tests) have been created for patients considering whole genome sequencing. These can be found here and should be given and/or discussed with the patient or their parent/carer.

Samples cannot be processed until the lab has all of the following forms correctly and fully completed:

Please note:

• Where appointments are conducted remotely, the record of discussion form can be completed virtually by following the Remote Patient Choice Policy.
• If you have a nominated consultee consenting on behalf of a patient over 16 who lacks sufficient capacity, you will need to complete the ‘Consultee Declaration’ form in addition to the ‘Record of Discussion’. This form does not need to be completed if the consultee is only consenting to the clinical test.
• For rare diseases where you are collecting samples from a patient and family members, you will need to complete one Record of Discussion form for each family member.
• Except for CNS tumours, for all adult cancer patients (solid, haemonc and CUP), the Cancer WGS Eligibility Form needs to be completed as part of the WGS submission to comply with the NHSE eligibility criteria.

The National Genomic Research Library

Any patient or family member who has WGS is given the opportunity to include their samples, genomic and health data to the National Genomic Research Library (NGRL). This library provides data and samples for research and participants may be re-contacted in the future where there are relevant research projects that may be of interest, or a new diagnosis is found. The patient’s choice whether to opt-in to the NGRL is documented on the Record of Discussion form. More information about the NGRL can be found here.

Collect the sample(s).

For WGS we require:

Further guidance on sample requirements can be found in the National guidance and Standard Operating Procedures (SOPs).

If using stored DNA

Stored DNA samples are accepted for WGS, subject to quality checks, but please contact the laboratory on gos-tr.wgsnorththamesglh@nhs.net to check that there is sufficient DNA.

Transportation of sample(s), test order form and record of discussion and request form to the North Thames GLH

Please note, we cannot submit samples for WGS until all required elements have been correctly submitted to the GLH.

Analysis and return of results conducted by North Thames GLH

The clinical report will be sent to the requesting NHS colleague by the appropriate lab within the hub.

Please note, many WGS cases will need to be discussed at an MDT. You must be prepared to attend an MDT if you wish to order WGS for your patient. If this is not possible then the patient should be referred to a clinician familiar with WGS and MDTs.

For Rare Disease WGS the North Thames Rare Disease Laboratory at GOSH will no longer routinely issue separate reports for the parents in trio/duo referrals where there is no primary finding in the proband. A report will be issued for the proband as usual. The laboratory will generate separate reports for parents where there is a finding in the proband that presents a significant recurrence risk to offspring or other family members.

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