Web Referral Form: Symptomatic FIT Service

This form is intended for requesting Faecal Immunochemical Tests (qFIT/FIT) by a clinician for low risk (DG30) and high risk (NG12) symptomatic patients according to local arrangements made with participating Health Boards (Aneurin Bevan UHB, Betsi Cadwaladr UHB, Cardiff & Vale UHB, Powys THB and Swansea Bay UHB ONLY)

Guidance

We would recommend the following for patients referred for lower GI symptoms in line with national guidance:

1. Clinical assessment of the patient by GP with abdominal and rectal examination
2. Recommended standard blood tests to include full blood count, ferritin, routine biochemistry (bone/liver/kidney), TFTs, coeliac serology if not done in the last 3 months. Consider faecal calprotectin for diarrhoeal symptoms (age <50)
3. FIT testing for patients satisfying the NG12 criteria only: Do not delay referral or wait for FIT results before referring to secondary care

NG 12- NICE suspected cancer guidelines (2 week wait):

Please refer to secondary care as normal alongside requesting the FIT test.
NICE recommend a referral within two weeks based on the following criteria:

1. Aged 40 and over with unexplained weight loss and abdominal pain** OR
2. Aged 50 and over with unexplained rectal bleeding OR
3. Aged 60 and over with Iron Deficiency Anaemia (IDA) or change in bowel habit (CIBH)
4. Any adult with a rectal mass or abdominal mass
5. Aged under 50 with rectal bleeding AND abdominal pain or CIBH or weight loss or IDA

**If appropriate, please consider direct access urgent CT abdomen for suspected pancreatic cancer as per NICE recommendation (https://cks.nice.org.uk/topics/gastrointestinal-tract-upper-cancers-recognition-referral/)

DG30- NICE guidelines: (Updated 2020):

(Please request FIT and if positive please refer to secondary care for further investigations)
Criteria in adults without rectal bleeding:

1. Aged 50 and over with unexplained weight loss or abdominal pain
2. Aged under 60 with Change in Bowel Habit or Iron Deficiency Anaemia
3. Aged 60 and over with Anaemia even in the absence of Iron Deficiency Anaemia

Information

• Suspected cancer: recognition and referral
• Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care
• Laboratory Handbook
• Patient information and instruction leaflets can be found here.

Please note:

• Once the referral is submitted, a symptomatic test pack will be sent within one working day to the patient's address, as specified on the form, via Royal Mail.
• It is the responsibility of the referring clinical to follow up the patient’s test results.
• Results can be accessed via Welsh Clinical Portal (WCP) or GPLink. No paper/email copies of results will be issued.
• Results will be available within one working days of sample receipt.

Contact 

Any queries about a Symptomatic FIT referral can be sent to:

phw.fit.symptomaticreferral@wales.nhs.uk. 

*Please be aware* - Cardiff and Vale referrals should be referred using the following link: https://phw.nhs.wales/services-and-teams/screening/bowel-screening/cav-symptomatic-fit-pilot/ 

Please complete all the questions below for the referral to be processed.

Form