Rapid diagnostic services

Patients over 18 years old who are experiencing one or more of the following criteria or symptoms should be referred to a RDC. 

• Does not fit, or fits multiple, 2WW pathways
• Experiecning unexplained weight loss
• Significantly elevated ALP
• Unexplained thrombocytosis
• Worsening malaise/fatigue
• Raised inflammatory markers
• Persistently raised calcium
• Worsening pain, including back pain
• Unexplained radiology findings with no obvious primary

  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 Symptom.’

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 service sees a cancer conversion rate of 8% with an average time to diagnosis of 21 days. Initial analysis finds that 40% of cancers are diagnosed at the earlier stages one or two. 

The clinics have detected serious non-cancerous disease in 30% of referrals. 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 either 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 other 2WW pathways, prior investigations/diagnostics are required when referring into the service. 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. 

From July, ‘Non-Site Specific cancer’ will be included into the scope of the cancer waiting times standards meaning a referral will no longer be able to be rejected by the clinic and can only be downgraded if agreed with the referring clinician. However, please continue to include the required information on the referral form to ensure the patient is seen in a timely manner.

5. Isn’t the service understaffed and having capacity issues?
There were previous issues with staff shortages which impacted capacity, however this issue has since been resolved and we are actively encouraging GPs to refer into the service for patients who meet the referral criteria.

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

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