Referral information for primary care health professionals

Who can access the service?

The rapid diagnostic centre (RDC) is open to referrals from primary care clinicians working in GP practices across the South Tees footprint (Middlesbrough, Redcar and Cleveland plus Hambleton, Richmondshire and Whitby). Out of area referrals will be considered where appropriate. Referrals are accepted from GPs and nursing staff.

Criteria for referral

Patients can be referred in to the service with the following criteria:-

• Gut feeling of cancer diagnosis – reasons to be clearly described on referral letter
• New unexplained and/or unintentional weight loss – please advise extent/duration of weight loss
• New unexplained constitutional symptoms including loss of appetite, fatigue, nausea, malaise, bloating
• New unexplained/vague abdominal pain
• Unexplained new or progressive pain including bone pain

The exclusion criteria includes:

• Patient has specific symptoms warranting referral to existing site-specific two-week wait pathway
• Patient is too unwell or unable to attend as an outpatient or needs acute admission
• Patient is likely to have a non-cancer diagnosis suitable for another specialist pathway
• Patient is currently being investigated for the same problem by another specialist team

How to access the service

Primary care referrals are through Choose and Book / e-Referral Service (e-RS). The RDC NSS service can be found using the following search criteria: –

• Specialty = 2ww
• Clinic Type = 2WW Non-specific symptoms
• Organisation or Site Name = FRIARAGE HOSPITAL SITE
• Service name = Rapid Diagnostic Centre Assessment Service-South Tees Hospitals NHS FT (Friarage)-RTR

Referrals are triaged by RDC clinicians – our aim is to do this within two working days of receipt of a referral. Once a patient is accepted, their appointment slot will be confirmed directly with them by one of the RDC team – please advise patients of this.

If a patient is not accepted by the RDC team, we will communicate our reasons for this with the practice and advise a more appropriate pathway.

Patient information leaflets are available through e-RS or our useful information page.

If you would like to discuss a referral prior to submission, please contact the team on 01609 763338.

Required filter tests

The following tests are required as part of the referral to RDC:-

• FIT (via Gateshead)
• Urine culture
• Full blood count
• ESR
• CRP
• Urea and electrolytes
• Liver function tests
• Thyroid screening
• HBA1c
• Bone chemistry
• CA-125 (women)
• PSA (men)
• B12 and folate
• HIV 1 or 2 antibody antigen
• Immunoglobulins an electrophoresis
• Coeliac antibodies
• Beta 2 microglobulins
• Serum free light chains
• Electrophoresis (urine) Bence Jones protein
• LDH

All primary care tests are available on a single collection template on WebICE via the GP Requesting tab and on the Vague Symptoms panel on the left hand side.

Please ensure all tests are requested prior to referral as it supports and speeds up the diagnostic process. Where concern is of cancer, referrals will be considered before the results of all tests are returned – please do not let this delay referral.

Where weight loss is concerned, please include up to date weight in the referral.

Secondary care tests

Once patients are accepted in to the service, secondary care tests will be arranged depending upon patient presentation. Diagnostics may include CT TAP (thorax/abdomen/pelvis), ultrasound or MRI. Endoscopy and/or colonoscopy will be requested if indicated.

Results of all diagnostic tests will be tracked and monitored by the RDC team while the patient is under the care of the RDC.

Primary care poster

The primary care poster with the information above can be posted to practices on request.

What happens after referral?

1. e-RS is monitored throughout the day and all referrals are triaged by the RDC team, including GP, advanced clinical practitioner and specialist nurses
2. After initial triage of the referral letter, one of the RDC clinicians will telephone the patient to further understand clinical history and symptoms and decide next steps. This will either be:
   a. accept – patient meets the criteria for clinic and is booked to come to the RDC clinic, or
   b. redirect – patient meets other referral criteria / alternative pathway and we will liaise with the referrer to ensure this is undertaken
3. Patient attends RDC clinic, additional filter tests are arranged, plus diagnostic imaging as indicated. Most patients will have a CT TAP. Diagnostic findings will determine onward pathway
4. All accepted patients are discussed at the RDC multi-disciplinary team meeting to agree appropriate diagnostic plan
5. Patients are supported by our cancer care coordinators and kept informed throughout their journey. The RDC cancer care coordinators provide a single point of contact for patients while they are under the care of the RDC
6. Patients are discharged from the pathway in one of three ways:
   a. cancer is diagnosed and they are formally handed over to the appropriate specialty MDT (multi-disciplinary team) for staging and treatment
   b. other significant diagnosis is made and they are referred to appropriate specialty for onward care and treatment, or
   c. patients are discharged back to the care of their GP with recommendations for onward management

RDC pathway for health professionals

The pathway is designed to support the 28 day faster diagnostic standard: