Reviewed on : 10 Oct 2023

Reviewed by : Michelle Park

Expires : 10 Oct 2025

2WW Lower GI Pathway for Coventry & Warwickshire 2023

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

GP Gateway Non Specific Symptoms Pathway for Coventry & Rugby

GP Gateway Non Specific Symptoms Pathway for North Warwickshire

GP Gateway Non Specific Symptoms Pathway for South Warwickshire

Exemptions:

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

Pre-investigations required:

• FIT testing request
• Digital Rectal Examination
• FBC (Hb and Ferritin), LFTs, and U&Es at time of referral, unless taken during the preceding 1 month (required before CTC or Colonoscopy)

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

If you do NOT email the FIT request form to uhc-tr.fitbcs@nhs.net, or request via TQuest, 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.

Please note FIT ordering is now available via tQuest. The Bowel Screening Hub have advised that several GPs are continuing to send an email referral as well as an electronic T-Quest request.  This is not required as it will result in duplicate kits being issued.

One T-Quest request is sufficient and will trigger the issuing of a FIT test.  During this transition period, if you wish to confirm that the T-Quest request has been received, please email the Bowel Screening Hub (Sarah.Orcherton@uhcw.nhs.uk), who will review and confirm.

If your GP practice does not currently use TQUEST but you are interested in discussing this with a member of the TQuest team please contact (Gregory.Tindall@uhcw.nhs.uk / Charlene.OKane@uhcw.nhs.uk). The FIT request form is attached, and will also be available on the PCICT Referral Tree in early December 2023 for North Warwickshire practices.

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

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

• Patient information leaflet to explain FIT process
• Your urgent suspected cancer referral (cancerresearchuk.org) Patient information leaflet for urgent cancer referrals

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

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 – follow link to GP Gateway Page

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:

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