2 Week Wait Lower GI Pathway

We have been working closely with GHNHSFT to make some important changes to the 2WW pathway for suspected lower GI cancer to reflect the latest NICE guidelines.  We’re confident that by implementing these changes and through all of us working together, we can make an important step towards enabling our county’s patients to be seen more quickly for their assessment and diagnosis.

From Tuesday 29th May 2018, there will now be two services available on the NHS e-Referral Service for suspected lower GI cancer:

  • 2WW Colorectal Outpatient Service: patients will be directly booked into an outpatient appointment slot as usual.
  • 2WW Colorectal Telephone Assessment Service: patients will be directly booked into a telephone appointment slot where an assessment of their fitness for any necessary diagnostic tests will be completed prior to any face-to-face appointments being arranged.  Please make sure that your patient is aware of the date and time booked for their telephone call and that they should not attend the hospital for this appointment.

A further revised 2WW referral form for Suspected Lower GI Cancer and a supporting ‘GP Referral Guide’ (available below) have been developed which clearly set out which patients are appropriate for each service, based on their age and symptoms.

  • Download the new referral form from G-care and use it for all 2WW lower GI referrals. Alternative versions of the referral form for integration with each GP clinical system are now available.
  • Provide an accurate representation of the patient’s symptoms and history on the 2WW referral form.
  • Complete the mandatory pre-referral tests outlined on the form in order to avoid significant delays to your patient’s pathway - the most important of these being an eGFR result from within the last 3 months
    • If the eGFR result is not available at the time of referral, please make a note on the 2WW referral form outlining the arrangements that have already been made for the patient to receive their eGFR blood test.
  • Direct patients to the appropriate service as indicated based upon their age and symptoms
    • Make sure that your patient is aware of the date and time booked for their telephone assessment and that they should not attend the hospital for this appointment
    • Choose the soonest telephone assessment appointment that is suitable for your patient.  If possible, please call your patient to let them know when their telephone assessment is booked for rather than deferring the appointment to allow time for a confirmation letter to be sent.

The new referral form has been future-proofed to include references to the new qFIT test which is anticipated for national roll out in June 2018.  Please do not refer patients against the qFIT criteria until the test is available locally and further information about its use has been communicated

  • Patients may not be fit for bowel preparation if they:
  1. Have CKD/AKI (a recent eGFR helps to provide the safest preparation or recognise when bowel preparation is unsafe)
  2. Have severe CCF e.g. grade IV (the volume of fluid could provoke pulmonary oedema)
  3. Are very frail (preparation involves a 24 hour fast, powerful laxative and the need to drink several litres of fluid)
  4. If they cannot follow the instructions provided (should have mental capacity and no language barrier. GHFT can help with these scenarios if alerted to them)
  • Patients must have capacity to give informed consent
  • Patients must be sufficiently mobile to change position independently on a trolley at least 8 times
2ww Lower GI Pathway GP Referral Guide

Please click the image below to open the full 2ww Lower GI Pathway GP Referral Guide by Symptom Guidance


Top tips in colorectal cancer
  1. Refer those with a TRUE UNEXPLAINED IDA (low Hb AND low ferritin) via the 2WW Colorectal pathway
  2. Dark red blood PR is always significant whether accompanied by anal symptoms or not
  3. A persistent (i.e.: greater than 6 weeks) change in bowel habit with increased frequency OR increased looseness chould be referred via the 2WW Colorectal pathway
  4. A change to constipation is a very poor predictor for significant colonic pathology. Refer ROUTINELY if patient fails to respond to primary care management
  5. It is important to take a family history which will help guide our risk assessment. Relevant family history for colorectal cancer risk should include extragastrointestinal tumours including ovarian, uterine, breast and thyroid
  6. Family history of colorectal polyps (adenomas) may have the same significance as colorectal cancer in the prediction of risk of inherited predispositiion to coloreactal cancer
  7. Flexible sigmoidoscopy is commonly used to investigate isolated anorectal type bleeding without any associated symptoms or risk factors. Please note direct access flexible sigmoidoscopy service is provided by GHNHSFT as well as AQP (In Health and Care UK)
Communication with Primary Care

Where a patient is given a diagnosis of colorectal cancer, the patient's GP will be informed by the end of the next working day. The call is made to the GP practice and if unable to talk to the GP directly a message is left with the receptionist with contact details of the CNS in case there are questions.

2ww Patient Leaflet Ordering

If you would like to order copies of the GCCG 2WW Patient Leaflet, please email your request to glccg.cpgleaflet@nhs.net or alternatively contact the Cancer Clinical Programmes Team via reception on 0300 421 1500.

Palliative Care - Top Tips - GHNHSFT

Please follow the resource link below to the End of Life section for GHNHSFT's top tips for palliative care.

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