Lower GI symptoms: letter to GPs October 2022

Following the publication of the national guidance for use of QFiT the GGC pathway, introduced during the Covid pandemic, has been reviewed by the co-signatories below and updated. The revised pathway is available here. Experience of using this pathway has been positive and it was found to be closely aligned to the subsequent national guidance, therefore no major changes have been made. There are however some aspects worth highlighting again :

• If rectal or abdominal mass is found on examination, no QFiT is required.
• Patients with acute or transient symptoms (less than 4 weeks) do not usually need QFiT testing. QFiT is not recommended for vague symptoms or assessment of weight loss.
• If patient is unable to complete a QFiT please ensure this is communicated in SCI referral
• For patients with persistent lower risk symptoms but negative QFiT, a repeat QFiT after 6 weeks is recommended.
• We advise that practices have a mechanism to ensure receipt and action on QFiT results. This is particularly important where referral is dependent upon the QFiT result. Please note that any comments contained within the laboratory result are recommendations only - no action is taken by the laboratories.

The endoscopy service will arrange QFiT testing, where appropriate, for patients with colorectal symptoms or iron deficiency anaemia who are referred by secondary care. There is no requirement for primary care to arrange QFiT for these patients prior to referral.

• Updated pathway and documents are on the NHS GG&C cancer referral guidance webpage
• The national guidance is summarised in an information leaflet for clinicians and for patients.

Please let me know if you encounter any significant difficulties with this pathway.

Yours sincerely,

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

Dr. Kerri Neylon, Deputy Medical Director for Primary Care, NHS Greater Glasgow & Clyde

Dr. Jack Winter, Clinical Endoscopy Lead, NHS Greater Glasgow & Clyde

Dr. Patricia Moultrie, Medical Director, Glasgow LMC