Allowing GPs to Book 2-week Wait CRC Investigations Directly-Will we Open the Floodgates?


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Deji Odofin1,Anne Pullyblank2,Eric Loveday2,Anne Lyons2
1Walsall Healthcare NHS Trust,2North Bristol NHS Trust

Abstract

Background

To meet colorectal cancer targets, we had a paper-based ‘straight to test' system for 2 week wait (2WW) referrals for patients under 80.  About a week of the pathway was wasted on nurse-led triage, and 62 day target performance was poor.  GPs were requesting direct access to diagnostics so we introduced a new electronic 2WW referral system in February 2015 allowing GPs to book investigations directly, aligned to 2WW symptoms for all ages. We present an evaluation of this service.

Method

Patients 1 year before and after introduction were evaluated for time to diagnosis and cancer pick-up rates.  Total referrals and cancer performance were evaluated as well as GP/patient satisfaction.

Results

In the first year, 681 patients went to clinic, 964 to CTC and 976 to colonoscopy/flexible sigmoidoscopy. Time to diagnosis reduced from 28 to 11 days.  The cancer pick up rate was 4.3 %. By improving time to diagnosis, 62 day performance increased from 69% to 84%.  However 2WW referrals increased by 11%, partly due to new NICE guidance expanding 2WW referral criteria.  By sending over 80s to test rather than clinic and allowing GPs to book directly, we reduced 2WW outpatient attendance by 27%, releasing capacity.  We had no adverse events and had good feedback from GPs and patients.

Conclusion

An innovative IT system allowing GPs to book 2WW tests reduced time to diagnosis and improved 62 day cancer performance. However this was offset by an 11% increase in 2WW referrals.