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REMEDY : BNSSG referral pathways & Joint Formulary

Lower GI - 2WW

Checked: 05-10-2020 by vicky.ryan Next Review: 04-10-2021

Service Overview

The 2WW lower GI services at NBT, UHB and WGH are for patients who meet the Lower Gastrointestinal Cancer Two Week Wait criteria. The services offers consultation with diagnostics and onward referral for treatment as required.

Contact details ADULT 2WW:

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to cancerservices@nhs.net

UHBW - Tel on 0117 342 7641 / 2 / 3 / 4 or email to Ubh-tr.fast-trackreferrals@nhs.net

 

 

*****NEW PATHWAY FROM 5th OCTOBER 2020******

Changes to colorectal pathway – from 5th Oct 2020

From Monday the 5th October the colorectal cancer 2ww pathway will be changing so that certain patients will need to have a qFIT test done and the result received before a decision is made about referral via the 2WW route. This pathway change excludes those patients with an abdominal, rectal or anal mass, unexplained anal ulceration or unexplained rectal bleeding in whom a FIT test would not alter their need for investigation. Please see pathway as a flow diagram

Patients with a negative qFIT are at lower risk of colorectal cancer and evidence suggests they can be managed in the community with appropriate safety netting (1). This will help relieve pressure on colonoscopy provision so that it can be concentrated on patients with higher risk of colorectal cancer.

The direct to test form on ICE and 2WW form have been updated to reflect these changes.

Patients with FIT values ≥ 10ug/g (positive FIT)

These patients should still be referred on the Lower GI (LGI) 2WW pathway for suspected colorectal cancer (CRC). This should be done by direct to test via ICE (if they meet the pre-existing straight to test referral criteria), or via eRS if direct to test is not possible. See local referral pathways in sections below.

Patients with FIT values < 10ug/g (negative FIT)

Patients who do not meet criteria for 2WW referral and who have a negative FIT should be managed in Primary Care with an agreed follow up plan with relevant safety-netting processes in place.    

If the patient has persistent unexplained symptoms and negative qFIT, GPs can seek advice and guidance from secondary care clinicians:

If a GP still has concerns that colorectal cancer is more likely despite a negative FIT then they can still refer in via the 2WW route including an explanation of their concerns. See safety netting advice in FAQs.

FIT Test

There is a risk that patients will not appreciate the importance of carrying out a FIT test and how crucial the result will be to decisions on their management. GPs are therefore encouraged to emphasise the need for the test to be completed and sent off quickly.

Thresholds for FIT result

  • A value of < 10ug/g will be used for a negative test
  • A value of ≥ 10ug/g will be used for a positive test 

Instructions for use of FIT - Information for GPs - Updated Oct 2020

FAQs

Colorectal 2WW Pathway - Frequently Asked Questions Oct 2020

(1)SWAG Cancer Alliance Primary and Secondary Care Guidance Lower GI 2WW Pathway during COVID-19 (Aug 2020)

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Patient Leaflet for 2WW Referral

2WW Patient Information Leaflet. - COVID-19 Edition - please issue this leaflet at time of referral.

Link to leaflet on CCG website: https://bnssgccg.nhs.uk/library/understanding-two-week-wait-urgent-referrals-and-covid-19/

 

 

NBT Referral Guidance

****COVID-19 Update (17.7.20): Direct to test via ICE has now been switched back on so please use this route for suitable patients.****

There are 2 ways to make a referral for  lower GI suspect cancer at NBT:

1. Direct to test. For Lower GI suspected Cancer at NBT please use the direct to test service via NBT ICE if criteria are met. Please refer to the NBT 2WW Colorectal pathway.

The NBT lower GI team ask that when making a referral please be sure to give the patient the  NBT suspected bowel cancer patient information leaflet regards the referral process.

Exclusions - Please note that there are exclusions to the direct to test service. These include patients over the age of 80 or are not fit for a colonoscopy or those who have limited or no capacity to consent. Patients who are not suitable for direct to test should be referred via the 2WW pathway as below.

2. 2WW eReferrral. If your patient does not fulfil the criteria for referral via ICE you will not be able to book them direct to test. However, these patients can still be referred via 2 week wait if you suspect that they may have cancer. Please refer these patients to a 2 week wait clinic via e-referral using the Lower GI Cancer referral form (word doc).   Please free text concerns on the 2WW form making it clear why ICE referral is not possible or not appropriate.

UHB Referral Guidance

****COVID-19 Update (17.7.20): Direct to test via ICE has now been switched back on so please use this route for suitable patients.*****

There are 2 ways to make a referral for  lower GI suspect cancer at UHB:

1. Direct to test. For Lower GI suspected Cancer at UHB please use the direct to test service via UHB ICE if criteria are met. Click on the title link for further information on the process.

Exclusions - Please note that there are exclusions to the direct to test service. These include patients over the age of 80 or who are not fit for a colonoscopy or those who have limited or no capacity to consent. Patients who are not suitable for direct to test should be referred via the 2WW pathway as below.

2. 2WW eReferral. If your patient does not fulfil the criteria for referral via ICE you will not be able to book them direct to test. However, these patients can still be referred via 2 week wait if you suspect that they may have cancer. Please refer these patients to a 2 week wait clinic via e-referral using the Lower GI Cancer referral form (word doc).  Please free text concerns on the 2WW form making it clear why ICE referral is not possible or not appropriate.

WGH Referral Guidance

For Lower GI suspected Cancer at WGH referrals must be raised using the Lower GI Cancer referral form (word doc).  The up to date form should be embedded in your EMIS system.

There is no Direct to test available at WAHT.

Resources

NICE lower GI tract cancer guidelines(2015) 

CKS Summary (2017).

SWAG Cancer Alliance Primary and Secondary Care Guidance Lower GI 2WW Pathway during COVID-19 (Aug 2020)