Faecal Immunochemical Testing (FIT) in primary care – an innovative approach to test safely, effectively and improve patient care

Hywel Dda University Health Board

The Covid-19 pandemic impacted colorectal cancer pathways adversely, with prolonged waiting times for investigations and delayed diagnosis and treatment. A pilot of Faecal Immunochemical Test (FIT) in secondary care during the pandemic saw a reduction in endoscopy referrals by 23% from pre-pandemic levels. Hywel Dda University Health Board proposed the development of a safe and effective FIT pathway in Primary Care, to reflect best practice and clinical evidence. Supporting this initiative was the establishment of a dedicated ‘FIT Hub’ to manage the tests so that those deemed to be at high risk of colorectal cancer could be prioritised and managed in a timely, safe, and effective way.

The development of the FIT pathway involved collaboration among multiple stakeholders, including senior clinical representatives from primary and secondary care, relevant service teams, and support from NHS Wales Health Collaborative and Digital Health and Care Wales colleagues. During regular stakeholder meetings, the principles of a safe FIT Pathway in primary care were discussed, addressing barriers and ensuring that patients with urgent suspected cancer experienced no delays in referrals due to the test. To ensure that communication letters to patients regarding the FIT outcome were appropriate and clear, the letters were co-produced with the patient experience team and modified based on patient feedback.

Input from colleagues was critical to enable the referrals to be successfully managed via the Welsh Clinical Communications Gateway, thus minimising the need for additional training for GPs. Effective primary care communications were established, including webinars for GPs introducing the new pathway.

The successful development and implementation of the FIT pathway in primary care culminated in launch across the Health Board in April 2023. Accessibility of FIT to Primary Care via FIT Hub, has streamlined the referral pathway for patients with suspected colorectal cancer. Resources are used more effectively, waiting times have improved and patients on the Single Cancer Pathway have timely investigations with the least possible delay.