Integrated Lower GI Pathway

Information about the implementation of the Lower GI Pathway, including FIT for symptomatic patients

This website will be the main point of information for health care professionals about the implementation of the Lower GI pathway, including the implementation of Faecal Immunochemical Test (FIT) for symptomatic patients.

This page will be updated regularly but if you need further information please email sheffieldccg.sybndcanceralliance@nhs.net.

Background

The South Yorkshire and Bassetlaw Shadow Integrated Care System is supporting the development of a system wide Lower GI Pathway. The Programme of work to develop a system wide Lower GI Pathway was initiated in January 2018, and will bring together the work undertaken by the Cancer Alliance and the Yorkshire and Humber Academic Health Science Network.

The National Picture

  • FIT testing to replace FOB for asymptomatic patients and Bowel Screening
  • Drive to increase early diagnosis of cancers
  • DG30 recommending FIT in low risk symptomatic patients
  • National recommendations around the FCP testing pathway
  • High risk patients-collection of evidence to inform future system transformation

The Local Picture

  • South Yorkshire, Bassetlaw and North Derbyshire Alliance to develop Business Case for FIT in symptomatic patients
  • Yorkshire and Humber AHSN-development and implementation of FCP pathway
  • South Yorkshire and Bassetlaw Shadow Integrated Care System-developing a system wide Lower GI Pathway which pulls both pieces of work together and maps impact

Pathology process

Pathology process - October 2018

Click here to download 
Slide1.JPG

Updates to primary care staff

This section will be updated with the messages sent to GPs and practice staff via their own CCG. Please click on the relevant title to open the communication.

Message sent to primary care w/c 29.10.18

Message sent to primary care w/c 12.11.18

Message sent to primary care w/c 10.12.18

Dates for diaries - WebEx sessions, meeting dates etc.

Session/meeting

Date and time

How to book

WebEx to discuss FIT implementation

Thursday 22 November 2018

5pm – 6pm

Email rachel.humphreys5@nhs.net to register interest

WebEx to discuss FIT implementation

Wednesday 23 January 2019

2.30pm – 3.30pm

Email rachel.humphreys5@nhs.net to register interest

WebEx to discuss FIT implementation

Wednesday 30 January 2019

5.30pm – 6.30pm

Email rachel.humphreys5@nhs.net to register interest

Useful documents

Please click here for a useful document from CRUK which explains the difference between FIT for screening and FIT for symptomatic 

Faecal Calprotectin in Primary Care as a Decision Diagnostic for Inflammatory Bowel Disease and Irritable Bowel Syndrome

Click here for the slides from the WebEx session from November 2018 

Click here for a useful document from the BDA about IBS and diet - this may be useful for practice staff to give to patients when giving them a FIT kit 

FAQs

 

Q

A

What should the Practice do if the kit and sample are returned to the Practice in the envelope?

The Practice should post in the sample. 

What should the Practice do if kit and sample are returned to the Practice without the envelope?

The Practice should send this on the normal transport as stability is fine

What is the shelf life of the patient pack?

The shelf life of the patient packs will be 12 months from when we receive them and slightly less by the time that they are delivered to individual GP surgeries

What is the shelf life of the patient pack once sample produced?

Once used the patient will send the sample back direct to the Lab. and the stability of the sample in the collection device is at least 7 days at ambient temperature.  The patient leaflet will advise that the test should be completed within 7 days of being given it.

 

Lab will analyse samples with up to a maximum of 10 days between GP issue and receipt in Lab.

 

How can Practices follow up on patient compliance?

As for other tests, Practices can search for tests results and undertake necessary action e.g. follow up appointment with patient to discuss results/next steps.

If a Practice added a Read code for when a test was requested, it will be possible to run a report of tests requested.

Why has a postal option been chosen?

Postage option was chosen by the patient group and will be reviewed in 12 months as part of evaluation of implementation.

How will a positive test be flagged to the GP/Practice?

GPs/Practices will follow their current practice protocol for accessing test results. Positive results will not be specifically flagged except in the usual way abnormal results are highlighted on ICE e.g. high PSA and AKI test results.

How will labels for the specimens  be produced?

These will be printed as a standard ICE label which will include the bar code. Name/date/DoB can be handwritten. 

What is the difference between FIT test for screening versus Symptomatic patients?

There are different levels of analysis for screening and symptomatic processes

 

Click here for a graohic that explains the difference 

 

How can we avoid any confusion for patients around undertaking their FIT for screening and FIT for low risk symptoms?

Patients should be advised that there are different levels of analysis for screening and symptomatic processes and if even if they have had a result from a FIT screening test a FIT provided by their GP for symptomatic patients also needs to be completed. This will also be included in the patient leaflet.  

Is the same FIT kit being used for FIT screening?

Procurement is still taking place and will be notified as soon as available.

 

 

What is the timescale for implementation of FIT for screening?

TBC

How will test results be returned and how will I know  the difference between FIT symptomatic and FIT for screening?

Test results for fit symptomatic will always be returned via the ICE system as for all other test results.   This is different to FIT for screening for which results will be returned  as for all screening on  screening specific letter.

How will test results be shown?

Test results will be shown as either positive or negative.

How should a positive result be handled?

A positive result should be handled in the same way as a raised PSA or AKI result.

How can Practices find out more/have an opportunity to ask questions of primary and secondary care clinical leads?

Another WebEx session has been arranged to provide information about the implementation and give primary care staff the opportunity to ask any questions. The WebEx session will be a repeat of the WebEx which took place on 7th November and will take place on Thursday 22 November, 5pm – 6pm. Please email rachel.humphreys5@nhs.net  to register your interest to join, Rachel will then forward on joining details.

 

Two further WebEx sessions have been scheduled for January – details of which will be circulated nearer the time

 

What testing will be done prior to the pathology system going live and how will the results be reported?

We will include full system testing as part of the implementation plan.  For result reporting we plan to use the same protocol that we use for cytology results i.e. send to GP systems via PMIP – any GP surgeries on the lists that we have who do not currently receive e results from Sheffield will be identified and set up.

 

If a test comes back abnormal,  what will it look like?  Is there any type of alert primary care can look out for?

Abnormal tests on ICE usually have an asterisk and appear red. This will therefore be the same for FIT positive results.

 

When will the FIT kit be sent to practices?

FIT patient packs will be distributed in January

What will the process for re-stocking be?

GPs will be stocked via their local hospital using the same system that they use for blood tubes etc.  Initial stock levels will be based on the number of patients >50 yrs at each practice and stock will be for a few months to minimise waste due to expiry. A restocking trigger level is to be agreed.

When will the testing/dummy run of positive results take place?

IT colleagues will test the reporting system in December – with a practice in Sheffield to start and then one from each area

What is the print time for the patient leaflet?

It is about 4 weeks (for the initial batch).

Who will put the label on the FIT kit?

Preference is for practices to put the label on the kit.  This will include

What if the sample is returned without a sample date on the kit?

The label will have a ‘printed date’ on it which will be used as a guide. As a result of this together with the sample type and stability the Lab can use this as a guide.

What is the correct application of the ICE label on the kit?

Clear instructions will be provided via ICE, in addition to a short video demonstration.  This will be available on the Cancer Alliance Integrated LGI Implementation resources webpages

What happens if a sample request form has been issued by GP with the kit but not returned with the sample?

The patient instruction leaflet will request that the sample request form is retained in the kit envelope when returning.  If a sample is received with this, Lab will check with GP.

What instructions will appear on ICE?

Correct application of label.

Criteria on performing a FIT

Is there any other information which might be useful to provide to patients at the time of providing the kit?

See IBS diet leaflet here