GG&C has accumulated a large data set which has contributed to a national evidence review of QFIT and recommendations for its use. This national guidance will shortly be published alongside the updated Scottish Referral Guidance for Suspected Cancer. Cancer Research UK are supporting GG&C to continue to be a leader in this field and to become an early adopter of this guidance. The local pathway has been developed with support from the GP Sub-committee.

The key aspects of the pathway are:

• Clearer guidance of when QFIT is/is not appropriate based on evidence of use
• Patients with asymptomatic iron deficiency anaemia included in pathway
• Updated and evidence-based prioritisation
  • Patients with QFIT 20 + are “Urgent – Suspicion of Cancer” (USC) priority
  • Patients with QFIT 10-19 “urgent” priority
  • Within USC there will be 3 further priority categories for colonoscopy based on risk of significant pathology on QFIT result
• Guidance for repeat QFIT testing

This is a whole system change and there are several changes being undertaken in secondary care to support this process including:

• Improvements for communication of vetting outcomes to patient and referrer:
  • explaining risk based on QFIT level and expected time frame for investigation
  • includes safety netting information
• Standardising vetting across GG&C to reduce variation
  • Evidence based vetting pathway depending on QFIT result and symptoms.
  • Vetting to OP clinic, CT or alternative pathway where appropriate
• Improved access for 2nd care to QFIT Testing

There are some aspects in the current pathway which remain are worth highlighting:

• Option for referral if patient cannot return/GP cannot access QFIT
• If rectal mass, abdominal mass or anal ulceration: no QFIT needed (refer as USC)
• QFIT result should be included with referral to optimise the patient care. If patient is unable to complete a QFIT please ensure this is documented in the referral.
• QFIT is a much better predictor of significant pathology than any abdominal symptom.
• Performance status included in referral can assist appropriate and timely investigation.
  
  

This pathway will accelerate diagnosis for the majority of patients. In addition it will reduce unnecessary invasive testing in patients with extremely low probability of significant pathology.

To support this update to the pathway the following content is available in this toolkit:

Pathway diagram

Primary Care engagement webinar

FAQs document

Example patient letter (USC referral and patient informed)

This pathway went live on 3rd February with Ordercomms, SCI referral templates and Lab results messaging to be updated.

Please let me know if you encounter and difficulties with this pathway,
With thanks,

Dr. Douglas Rigg, GP Lead for Cancer, NHS Greater Glasgow & Clyde