Referral information for health professionals

Who can access the service?

The RDC is currently open to referrals from South Tees GPs (Middlesbrough, Redcar and Cleveland plus Hambleton, Richmondshire and Whitby). Primary care referrals can be made via Choose and Book / e-RS. There is also a referral pathway for emergency department clinicians within South Tees Hospitals NHS Foundation Trust.

If you are not part of that cohort and would like to discuss the possibility of a referral, please contact the team on 01609 763338.

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 at referral
New unexplained and unintentional weight loss – please advise extent / duration of weight loss
New unexplained constitutional symptoms of four weeks or more (less if very significant concern). Symptoms include loss of appetite, fatigue, nausea, malaise, bloating
New unexplained vague abdominal pain of four weeks or more (less if very significant concern)
Unexplained new or progressive pain including bone pain, of four weeks or more

The exclusion criteria includes:

Patient has specific alarm symptoms warranting referral onto 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

If you are unsure, and would like to discuss a patient prior to referral, please call the RDC referral helpline on 01609 763338 (Monday to Friday 8.30am to 4.30pm) o9r email the team at [email protected]

All referrals are triaged prior to acceptance. If a referral is more appropriate for another service, we will advise of this prior to rejection on the system.

Primary care (GP)

GPs can refer to the service through Choose & Book / e-RS using the following search criteria:

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

Please note: All bookings are provisional until the referral has been triaged and the appointment slot confirmed by the RDC team – please advise patients of this.

Patient information leaflets can be printed through Choose and Book. However, please contact the team if you would like us to forward some hard copies through for the practice.

Filter tests

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

General practice tests (1st level filter tests):

CXR
HBA1c
Urine Dipstick
Bone
FIT
CA-125 (Women)
FBC
PSA (Men)
ESR and/or CRP
Immunoglobulins & ElectrophoresisU&E with eGFR
B12/Ferritin/Folate (if anaemic)
LFTS (including globulins)
TTG AB (if anaemic)
TFTS
HIV 1 or 2
Where weight loss in indicated, please include up to date weight in the referral

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

When the patients come to clinic, secondary care tests may include (list is not exhaustive and will depend upon clinical presentation of patient):

LDH
CEA
CA19-9
Calprotectin (if indicated)
Clotting (if indicated)
Diagnostics will involve CT thorax/abdomen/pelvis and endoscopy/colonoscopy as indicated. Not all patients will necessarily be scoped depending on CT result.

Emergency department (ED)

The RDC referral form is on WebICE, on the new services tab, under services page 2.

On the first screen you will be presented with a summary of the inclusion and exclusion criteria. Please enter your name and contact details and the name of the responsible consultant.

On the second screen the majority of fields will default for you: user, requesting consultant, location, category and priority. These can be left to default – altering priority from routine will require you to enter a bleep / contact number.

Please enter your reason for referral and or describe the clinical symptoms in the global clinical details box on the second screen then accept the request as usual.

What happens after referral?

Choose and Book and WebICE are monitored throughout the day and all referrals are triaged by the RDC team, including GP hospitalist and cancer specialist nurses.
We 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 at Friarage, or
b. reject – patient meets other referral criteria / alternative pathway and we will liaise with the GP practice / ED to ensure this is undertaken
Patient attends RDC clinic, additional filter tests are arranged, plus diagnostic imaging as indicated. Most patients will have a CT thorax / abdomen / pelvis. Diagnostic findings will determine onward pathway.
All patients referred to the service are tracked by a Cancer Care Coordinator to ensure patients are pulled through the system in a timely manner. The RDC Cancer Care Coordinators provide patients with a single point of contact while they are on the pathway.
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)
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