GP Chest X-rays - improving access to CT when there is suspicion

As part of the move towards the nationally described optimal lung cancer pathway, as of Monday 14th May there will be changes to how GHFT’s radiology teams handle GP referred CXR. These changes will speed up access for CT scans so that the right patients can be access important treatment sooner.

  1. All patients attending for a CXR need to be informed that they may be recalled for a CT scan if there is anything on the CXR that needs further clarification.  Patient will be given leaflets explaining this when they attend for the CXR, but GPs should also inform them of this process at the point the Xray is requested. 
  2. All CXRs will be reviewed immediately within the radiology department
  3. For patients whose Xrays are concerning for malignancy (CX3 code)
    1. Radiology will automatically recall patient for CT scan within 7 days
    2. Report will be sent back to GP with findings and instructions.  On receipt of report GP should send fast track 2ww referral through ERS and will be able to book into a next day ‘virtual clinic’.  GP to contact patient to explain that they are being referred on a suspected lung cancer pathway.  Urgent U+E will also be required if not performed in last 3 months to enable contrast CT to be performed.
    3. Lung cancer team will review referrals in virtual clinic daily and will arrange urgent 2ww appointment after CT scan.
  4. For patients with abnormal CXRs with low concern for malignancy (CX2 code)
    1. Where CT is required for clarification, this will be arranged directly by radiology and report will go back to GP advising them to wait for the result before taking further action.
    2. Where result requires clinical correlation (eg probable infection) then report will go back to GP with advice, eg repeat CXR in 6-8 weeks.
  5. Where CXR is not concerning for malignancy (CX1 code) then report will go back to GP as usual

Historically GPs would have to receive a CXR report, make a clinical decision and then request a CT. These changes will take out some wasteful duplication in the pathway and will save days from the lung cancer pathway, helping our patients access the 62 cancer quality standard (from referral to treatment).

This is not the only mechanism of 2ww referrals, individuals can still be referred through the normal route if there is strong clinical concern.  In order for the patient experience to be optimised it is important that when a GP requests an x-ray the patient is prepared that a CT may follow if further investigation is required. It is also vital that if you are suspicious of Cancer this conversation is had at point of referral.

For any further information please contact l.carey1@nhs.net