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Lower GI 2WW


Information and referral forms for 2WW GI Lower

Lower GI 2WW

General Indications for Referral

See below

For Coventry & Rugby specific Lower GI Pathway incorporating FIT testing and UHCW Non-Specific Symptoms Pathway scroll down to Coventry Guidance

Rectal Bleed Clinic: New symptoms of bright red rectal bleeding should be referred to the respective Rectal Bleed Clinic or Colorectal Clinic unless there is an additional reason to suspect colorectal cancer.

ALL patients referred for suspected Lower GI cancer should have a FIT test before referral, and the result included on the 2WW form.

If there is insufficient time to wait for FIT results you should indicate that a FIT has been sent to the patient and the results are pending.

Pre-investigations required:
  • FIT testing requested at time of referral (see below)
  • Digital Rectal Examination.
  • FBC (Hb and Ferritin), LFTs, and U&Es at time of referral, unless taken during the preceding 1 month.

Referring patients who meet 2WW criteria

The 2WW Lower GI form has a dual-purpose allowing referring clinician to select appropriate NG12 clinical criteria and also generate a request to order a FIT.

Please tick this box as it allows secondary care to prioritise and book patients for colonoscopies and other diagnostic tests, for example CT Colonography (CTC).

Recent bloods (EGFR / U&Es) in the last 3 months are required before CTC or Colonoscopy.

Please provide results or where possible arrange for the patient to have appropriate blood test.

Please send the referral form directly via eReferral AND Email to uhc-tr.fitbcs@nhs.net

If you do NOT email the form to uhc-tr.fitbcs@nhs.net a testing kit will NOT be posted to the patient.

Please stress the importance to patients that they need to complete their FIT as soon as possible. A leaflet explaining how to collect a sample will be included with the testing kit.

Follow this link to a video explaining the role of FIT in the diagnostic pathway for bowel cancer

FIT results of more than 10 are deemed positive – patient has a 1 in 4 chance of Lower GI cancer.

When FIT is less than 10 it suggests a low probability of Lower GI cancer, although these do occur. Patients with bowel cancer and a FIT less than 10 often have other symptoms.

Follow this link to a video walkthrough of the Lower GI – 2WW referral form and Symptomatic FIT request form.

Referring symptomatic patients who DO NOT meet the 2WW criteria

For information on referring symptomatic patients who do not meet the 2WW criteria, visit the Faecal Occult Blood Testing (FIT) – GP Gateway Page


Follow this link to a video explaining the role of FIT in the diagnostic pathway for bowel cancer

Consider handing the patient a Cancer Research UK Information Sheet – follow link

FIT Testing

FIT Testing – follow link to GP Gateway Page



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Coventry Guidance  

UHCW Lower GI Pathway for Coventry & Rugby Patients August 2023

The University Hospital Coventry and Warwickshire (UHCW) NHS Trust have introduced the West Midlands Cancer Alliance Lower GI pathway

NICE has published guidance on the use of FIT in patients with symptoms of bowel cancer. This guidance replaces DG30 and has prompted an update to NG12.

This pathway seeks for all patients, where clinically appropriate, to have a FIT test completed prior to referral



For appropriate patients with a suspicion of Lower GI cancer a FIT test is required unless there is a rectal mass or anal ulceration /mass

If FIT positive refer 2WW Lower GI route

If FIT negative review and safety net by considering management using Coventry & Rugby Non Specific Symptoms Pathway or other suitable route as per flowchart above

See also GP Gateway Non Specific Symptoms Pathway for Coventry & Rugby

Key Referral Documents and Links

  • Revised Referral forms (see links right)
  • 2WW Lower GI Referral Form incorporating the changes for FIT negative patients (see link right)
  • Non-Specific Symptoms Referral Form incorporating appropriate FIT negative patients
  • FIT Referral Form: the link is also available here FIT Request Form 2022  GP Gateway (coventryrugbygpgateway.nhs.uk). Do not refer to local Trusts or in parallel with a 2WW

Patient Resources

Primary Care Resources and Guidance:

  • Information Pack to Support Implementation of Internal Safety Netting and Text Message Processes Follow this link
  • Coding in Primary Care; to Support Payments Associated with IIF


UHCW Advice and Guidance tbc

Contacts at UHCW

For queries associated with Non-Specific Symptoms Pathway please contact:

Dr Murthy NSS Clinical Lead

Dr Lye Quen Hon Consultant Radiologist

John Elliott Head of Cancer Services

Assurances on FIT Turnaround Times

Please discuss with your patient the importance of completing the FIT test. This will support the onward referral and the hospital will be able to prioritise which test is best for the patient.

To support a timely turnaround, it is crucial to inform patients of the following:

  • The FIT testing kit will send through the post
  • As soon as they receive the kit, they should do the sample and return the kit as soon as possible, ideally within 1-2 days. It important to impress on the patient the urgency with which they do this in order that you receive the result as soon as possible allowing the onward referral to be made.
  • Highlight the patient information leaflet which explains how to take the sample
  • If you would like to request FIT kits for demonstration purposes only and to retain within the practice please complete the attached request form

To provide assurance on Bowel Screening Turnaround times a recent patient case study is detailed below:

Patient presents to GP; completes blood forms and requests FIT test 31/7/23
FIT received by patient and completed same day 3/8/23
Results shared with referring GP 10/8/23
GP call to patient and 2ww referral to Lower GI arranged (FIT >10) 10/8/23
Patient triaged and booked into appropriate 2ww clinic 11/8/23
Patient attends virtual OP clinic and discusses options with clinician 16/8/23
Patient booked for Endoscopy 23/8/23


The ICB is also developing a webinar to support primary care with the implementation of the revised pathway. It is anticipated this will be distributed within the next month

The ICB Cancer Transformation Team is working directly with both SWFT and GEH to ensure this pathway will follow – deatils will be notified when available

If you have any queries please contact Michelle.Park4@nhs.net AND Dionne.Trivedi2@nhs.net





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