SP 3.02 Quantitative FIT to Guide Colorectal Cancer Pathway Referral in Primary Care
Alexandra Robinson, Bheemanakone Harish BabuAbstract
Aims
To assess compliance with NICE guidelines for faecal immunochemical Testing (FIT) referral criteria and the outcomes of referrals from General Practice (GP) to colorectal FIT clinics. This re-audit evaluates improvements following interventions from a previous cycle.
Methods
A retrospective audit of GP referrals to the FIT clinic was conducted over two three-month periods: Cycle 1 (1 October 2023 to 1 January 2024) and Cycle 2 (1 August to 1 October 2024). A total of 291 referrals in Cycle 1 and 341 in Cycle 2 were analysed using cancer pathway referral forms. Compliance with referral criteria was assessed, including physical examinations, pre-referral blood tests, and investigations for FIT-positive and negative cases. Interventions between cycles included feedback to practice managers, highlighting the use of the "rule-out" proforma for those unlikely to tolerate colonoscopy and targeted education.
Results
In Cycle 1, 83% of referrals were appropriate, 68% had valid blood tests within 12 weeks, and 61% included documented abdominal and PR examinations. In Cycle 2, appropriate referrals increased to 86%, valid blood tests improved to 92%, and documentation of abdominal and PR examinations rose to 70%. The most common inappropriate referrals in Cycle 1 involved long-standing iron-deficiency, while in Cycle 2, issues included referrals without required FIT tests and patients already under specialist care.
Conclusions
Interventions improved the appropriateness of FIT referrals through better awareness of the dedicated IDA clinics and improved documentation of physical examinations and blood test results. Further improvements are needed to address inappropriate referrals and enhance GP training.