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REMEDY : BNSSG referral pathways & Joint Formulary

Lower GI - 2WW

Checked: 03-07-2020 by vicky.ryan Next Review: 02-07-2021

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.

Introduction of FIT testing in suspected Colorectal Cancer 2WW Pathway from 6th July 2020

From 6th July 2020: When referring for possible colorectal cancer (excepting those patients with rectal bleeding, iron deficiency anaemia, a palpable mass, or obstructive symptoms) please give the patient a FIT kit to complete at the point of referral. The results of this test will enable the secondary care clinicians to decide the best next steps for the patient. Please ask the patient to complete and send the test back promptly to minimise delays.

The results of the FIT test will be used by secondary care. You should not delay the patient's referral as you do not need to wait for the result.

Instructions for use of FIT - Information for GPs

At time of referral please issue the patient information leaflet below:

BNSSG  2WW Patient Information Leaflet. - COVID-19 Edition

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: Direct to test via ICE is currently suspended. Refer as 2WW on eRS using the Lower GI Cancer referral form (word doc). The up to date form should be embedded in your EMIS system. ****

The advice in italics below does therefore not currently apply.

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

1. Direct to test.  COVID-19 Update: Direct to test via ICE is currently suspended. Refer as 2WW on eRS. 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: Direct to test via ICE is currently suspended. Refer as 2WW on eRS using the Lower GI Cancer referral form (word doc).  The up to date form should be embedded in your EMIS system.****

The advice in italics below does therefore not currently apply.

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

1. Direct to test. COVID-19 Update: Direct to test via ICE is currently suspended. Refer as 2WW on eRS. 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).