North Bristol Trust has recently changed its colorectal referral pathway. Referrals can now be made only through the new referral route on ICE.
So far, they have received the following feedback:
- “the new pathway looks fantastic…simple and understandable which is great for those of us easily bamboozled by multiple pathways from multiple departments”
- “Thank you…the use of ICE is also very welcome, makes the job that little bit easier and every little helps”
- “I have just done my first 2WW colorectal pathway referral via ICE. It is a brilliant system, very straight forward. Well done”
NBT was aware that the previous colorectal 2 week wait pathway did not meet the NICE guidelines for best practice. Additionally, a number of GPs and service users suggested ways in which the pathway could be improved. NBT therefore undertook a large scale review of the pathway. During this review the service held regular discussions with a large number of GP groups about how the pathway could be adjusted to suit their needs. We also aimed to make the pathway more streamlined for patients to ensure that diagnostic tests and decisions were made at the earliest possible stage. As a result of this review two significant changes have been implemented:
Change in clinical criteria: The significant change relates to the primary diagnostic method. Currently, a large proportion of patients have a CT colonography (CTC) as their primary diagnostic test. This procedure takes a significant amount of consultant radiologist’s time to report and therefore patients are not able to be told the outcome of their diagnostic examination at the time of their appointment. They might need a second appointment to plan their treatment and/or a colonoscopy to treat any abnormality detected. Through the changes being implemented, the majority of this group of patients will now go for a colonoscopy instead. This is considered by NICE as the preferred diagnostic treatment, as any polyps detected can be removed at the time of the procedure, and a colonoscopy detects polyps under 6mms which are currently not reported on CTC. Additionally, patients would receive their diagnostic within two weeks and be told their results at the time of their appointment. This should save 3 weeks of their current pathway. In addition, patients over 80 will also go straight to test and will no longer have a clinic appointment which will save them a hospital visit.
Offering direct access to endoscopy: This means that the GP will be able to request the diagnostic examination through ICE. GPs will be able to follow the patient’s symptoms on the ICE portal and it will help to guide the GP into selecting the appropriate test.
Following the referral being made on ICE, NBT will organise the test and will ensure it takes place within 2 weeks of the referral. If the test result shows cancer or significant non cancer abnormality then NBT will pick up the care of the patient, and will then proceed with possible treatment options. If the results are normal or show no significant abnormality, then the care will remain with the GP, although appropriate advice and guidance will be provided.
More information is provided on the following website www.nbt.nhs.uk/colorectal2weekwait or if you would like to discuss further then please feel free to contact the team via Anne.Pullyblank@nbt.nhs.uk; Ann.Lyons@nbt.nhs.uk or Niall.Prosser2@nbt.nhs.uk.