1. Worcestershire Colorectal Cancer 2ww Pathway
Deb Nicol
Consultant Colorectal Surgeon
Colorectal MDT lead
Mel Kemp
CNS Lead – colorectal 2ww
Dawn Webb
Colorectal Support Officer

2. NBCA 2017 data
Worcestershire colorectal unit – 4th / 5th busiest in the UK
90 day mortality 1.9% compared to national average 3.2%.

3. NICE Referral Guidelines

4. NICE Referral Guidelines

5. EAG Referral Guidelines

6. Colonoscopy / CT colon / CT Staging - CT/MRI/Histology
Current 2WW system
2WW referral
Consultant led clinic
Colonoscopy / CT colon / CT
Staging - CT/MRI/Histology
MDT Discussion
Consultant Clinic
Surgery / Chemo / RXT
62 days
10-14 days
14 days
4-5 weeks
14 days
2-7 days
5-10 days
Day
10-14 days

7. The Independent Cancer Taskforce recently published a report, “Achieving World-Class Cancer Outcomes: A Strategy for England ”
Recommends that we should aim to treat or refute a cancer diagnosis within 4 weeks of referral for 95% of patients by 2020.

8. Challenges

9. Challenges Volume of referrals FIT screening, refusal of inappropriate
Target 93%
Target77%
Volume of referrals
Time to clinic appt
Patient availability
Investigation waiting times
Theatre capacity
FIT screening, refusal of inappropriate
Nurse led telephone triage
Downgrading / discharge protocol
Radiolology / endoscopy
Theatre realignment

11. Colorectal Telephone Assessment Clinic
A Change To The Way Colorectal Referrals Are Managed
Introduction of a nurse led 2WW telephone triage service will bring significant improvement to the current waiting times
A Colorectal Nurse Specialist will triage the patient’s referral within hours
Using an algorithm, patients will be triaged through a telephone assessment to the most appropriate investigation/ assessment
Implementation will begin 1st Nov 2018 and will be rolled out across the county over the next 4 months

12. New Colorectal 2WW Referral Form

13. FIT Testing Based in pathology WRH
Primary care requesting as per NICE guidelines
Available from 1st December 2018

14. New 2WW system 2WW referral Nurse led telephone triage
Colonoscopy / CT colon / CT
Staging - CT/MRI/Histology
MDT Discussion
Consultant Clinic
Surgery / Chemo / RXT
62 days
1-2 days
7-14 days
2 weeks
0-7 days
2-7 days
5-10 days
Day
10-14 days

15. Primary Care Support At point of referral: Patient information leaflet
2WW referral form
Tests
U&Es (within 24hrs)
Ferritin
FIT test (If appropriate)
Patient available over next 4 weeks (2 weeks unavailability is the maximum acceptable)

16. Protocol for refusal or downgrading of 2ww colorectal referral
2WW referral received from GP:
• Incomplete form
• Does not meet criteria for 2WW
• Appropriate blood tests not included / requested
Nurse telephone triage:
• Unable to contact patient / unable / unwilling to attend urgent investigation
Consultant clinic appointment:
• DNA x1
• DNA x2
Investigation appointment – Endoscopy / radiology:
• Reschedule by patient x1
• Reschedule by patient x2
Letter (1) to GP with referral not accepted (not on pathway)
Letter (2) to GP (pathway ends)
Letter (1) to GP, routine referral recommended (pathway ends)
Send one further appointment
Discharge, (3) letter to patient and copy to GP (pathway ends)
Letter (5) to patient to reinforce urgency
Discharge, letter (4) to patient and copy to GP (pathway ends)
Routine investigation, letter (6) to patient and GP (converted to routine pathway)

17. Worcestershire Colorectal Cancer 2ww Pathway
Any questions or concerns please contact:
Mel Kemp/ Dawn Webb
CNS Lead – colorectal 2ww
Direct line Ext 30985
Main CNS Office Ext 30329
Deb Nicol
Consultant Colorectal Surgeon
Colorectal MDT lead