Rapid diagnostic services

Patients over 18 years old where there is concern for a cancer but where their symptoms do not fit a site-specific pathway, or fit multiple pathways.

Reasons for referral:

• Unexplained weight loss >5% body mass and not explained by any other condition
• Significantly elevated ALP > 2x the upper limit of normal on 2 occasions
• Unexplained thrombocytosis in patient over 40 on more than one occasion
• Persistent non-specific abdominal symptoms (Lasting more then 4 weeks)
• Worsening malaise/fatigue with no other medical explanation and concern for malignancy
• Raised inflammatory markers and concern for malignancy as a cause (please exclude infection/ inflammatory and rheumatological conditions)
• Persistently raised calcium with no explanation e.g. hyperparathyroidism
• Worsening pain, including back pain with concern for cancer as a possible cause
• Unexplained radiology findings suggestive of cancer where there is no obvious primary
• Where the GP has a gut feeling something is not quite right

Before referral please make sure that patients have had filter blood tests done including FBC, renal, liver bone, inflammatory markers, TFT, HbA1c, Ca125 (women) PSA (men). These may help with possible diagnosis or direct more appropriately towards a site-specific pathway.

HIV tests should be done in patients with weight loss. Myeloma screens should be considered.

Referral Forms on DXS

1. All suspected cancer referral forms can be found on the SEL 2WW Cancer Landing page. For RDC/NSS referrals select ‘Rapid Diagnostic Clinic/Non-Specific Symptoms’ 

2. The forms can also be found in the folder directory on the left-hand side by clicking on Cancer and select ‘Rapid Diagnostics 2WW.’ All of the required documents will appear.

3. You can also use search using keywords. Keywords for these documents would include any of the following: Rapid; Access; 2WW; Cancer; Diagnostic.

4. To add the documents to your favourites, select the document, click on the star and select add. (You can choose any name for the favourite, but it is recommended to keep it as it is).

5. If you want to remove it from your favourites, just click on the document, go to the star, click remove.

  Referral Forms on the Referrals Optimisation Protocol (ROP) – Bromley Practices

1. All suspected cancer referral forms including the Rapid Diagnostic Clinic referral forms can be accessed via the Referrals Optimisation Protocol: Cancer / 2 Week Wait – Referrals – Rapid Access Diagnostic Clinic Referral Form (non-specific Ca symptoms). 

2. Patients should be provided with the Two Week Wait Patient Leaflet; you will be automatically prompted to print this when you access the referral form. 

3. You should follow your local cancer safety netting process.

Finding the Clinics on eRS

1. Under the Directory of Services, in ‘specialty’ select ‘2WW’, and ‘clinic type’ select ‘2WW Non-specific symptoms’ & click ‘search’ to bring up all available clinics. Clinics will be ordered by distance nearest to patient’s postcode.

2. There are 3 Rapid Access Diagnostic/Non-Specific Symptom Clinics in SEL, at Guy’s Hospital, Queen Elizabeth Hospital Woolwich, and Princess Royal University Hospital (see below). 

3. We do not recommend using the ‘Clinical Term’ search function as these clinics cannot be found by searching for the clinic name. In fact, searching ‘rapid access’ will return the clinical term for ‘rapid access chest pain clinic’ which these patients should not be referred to for suspected cancer.

The services in South East London have a cancer conversion rate of between 4% to 6% and arrange onward referral to appropriate Oncology teams.

Patients may be diagnosed with non-cancer conditions during their investigations and onward referral will be arranged where appropriate or the GP may be asked to arrange if necessary.  

Each clinic also offers a comprehensive holistic assessment which incorporates both physical and mental health aspects.

We continue to work with primary care colleagues to increase the awareness and utilisation of the service through either GP Bulletins, practice meetings and other primary care forums such as PLTs.

The engagement with primary care has allowed us to get an understanding of the issues with accessing the service and also allow us to have open conversations about why practices may not refer to the service.

We have summarised the queries and comments which have been raised through this engagement, below:

1. I thought the service was only offered at GSTT?
The original clinic opened at GSTT but has since expanded to PRUH (April’22) and QEH (Sep’22). You can refer your patients to any of the clinics.

2. I can’t find the referral forms on DXS.
When the service was set up on DXS it was originally listed as GSTT Rapid Access Diagnostics Clinic and when the PRUH/QEH services were added they were included under GSTT clinic folder. Primary Care colleagues raised concerns this was confusing and made it difficult to find the clinics on DXS; which led to us changing the name to Rapid Diagnostic Clinic/Non-Specific Symptoms.

3. Isn’t the referral age >40 years?
When the service commenced at GSTT the referral age was originally >40 years however as the service has expanded across sites and capacity has increased, the referral age has changed to >18 years.

4. Too much information is required on the referral form/referrals are being rejected.

As with all 2WW pathways, prior investigations and diagnostics are necessary when referring patients to our service. This helps ensure that the referral is appropriate— for example, if a patient's PSA is elevated, they should be referred through the prostate pathway.

Please familiarise yourself with the tests required ahead of a referral to your local RDC, such as the group blood test for NSS, as without these results being available, the ability of the team to assess the patient rapidly and comprehensively is significantly impacted. 

‘Non-Site-Specific Cancer’ is now included in the cancer waiting times standards. As a result, referrals should no longer be rejected by the clinic unless cancer has been definitively ruled out, or the patient is already under active investigation for cancer. During triage, referrals may be redirected to a more appropriate team if necessary.

To ensure your patient is seen promptly, please continue to include all the required information on the referral form.

Further FAQs and common issues will be added to this document as they arise.

If there are any other barrier or issues which you have encountered and would like to discuss, please contact gst-tr.selca@nhs.net 

Guys Hospital: 

Phone: 0207 188 0359

Email: gst-tr.rapidaccessdiagnosticclinic@nhs.net 

Princess Royal University Hospital (PRUH): 

Phone: 01689 863 191

Email: kch-tr.pruh-rdc@nhs.net

Queen Elizabeth Hospital (QEH): 

Phone: 020 8836 6177

Email: lg.qeh-rdc@nhs.net