GGC - Referral Management
Dear Colleagues,
Final phase of roll out of pilot for GP Direct Access CT Chest, Abdo & Pelvis
Start date: 1st October 2022 (All GGC HSCP areas and cross border practices using GGC radiology)
Following successful pilot in NW Glasgow HSCP area, we are now ready to complete the rollout direct
access to CT scanning across the health board area. This is for patients over 40 where there is a
significant suspicion of cancer but with no obvious localising symptoms. The main group of patients
will be significant weight loss with no obvious cause. Please find attached the pathway, ICE change
document and full background. This has been adapted from the original proposals from the Scottish
Clinical Imaging Network.
We would highlight the following points:
Referral Criteria
1. Clinical assessment of patient by General Practitioner leading to very strong suspicion of suspected underlying malignancy with, for example, unexplained significant weight loss of > 10% body weight.*
2. If there is any indication of localising clinical features or investigations to suggest malignancy
in a specific system, direct referral to secondary care should be made using the appropriate established USoC referral pathway without ordering a CT scan. This ensures appropriate tracking and waiting times targets are activated.
3. Prior to requesting a CT scan of chest/abdomen/pelvis the GP must ensure the following has
been completed.
o Appropriate history & examination including psychosocial assessment
o Relevant blood testing (including FBC to exclude anaemia and blood cancers and eGFR if not done within the last 3 months to allow for a contrast scan)
o CXR
o Consideration of principles of realistic medicine
4. CXR should show no evidence of primary intrapulmonary malignancy. Abnormal CXR should
use respiratory referral pathways.
5. Patient is 40+ years of age. For patients under 40 use of existing referral pathways and/or discussion with consultant colleagues initially. Ordercomms will ask you to confirm that the patient is over 40 before allowing referral to be submitted.
6. Exclude pregnancy. If patients are known to be pregnant CT CAP is not an appropriate investigation. If significant concern discuss with obstetrician. If possibility of pregnancy cannot be excluded discuss with radiologist prior to referral.
*Useful guidance on assessment of unintentional weight loss can be found in BMJ Best Practice and a BMJ clinical review for older adults
Ordering
You will need the following information to complete the request:
- eGFR
- Pregnancy excluded (including LMP or reason pregnancy is not possible e.g. hysterectomy)
- Safety questions: history of asthma, diabetes on metformin and/or contrast allergy?
- Weight (if over 118kg), interpreter requirement, assistance needed and preferred site.
You will also be asked to confirm your suspicion of cancer with no obvious localising features and
whether alternative diagnoses have been considered.
To access this test, use ordercomms radiology panel where it is now visible in the from “Common
Requests” page.
For cross border practices who do not have access to ICE Ordercomms radiology:
- Use existing mechanisms for radiology referral.
- Ensure that your practice has a robust system for following up radiology requests and results if you do not use electronic ordering and report receipt (by EDT) .
- You will need to complete all of the safety details on request forms (also highlighted above) to access this investigation
- Please include relevant clinical data to demonstrate referral criteria met.
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, Douglas.rigg@nhs.scot