REMEDY : BNSSG referral pathways

Endoscopy

Checked: 15-11-2017 by Rob.Adams Next Review: 15-11-2018

Referral Guidance - Endoscopy

Due to problems with capacity, requests for routine scopes at UHB and NBT have been suspended until further notice (unless criteria for other providers are not met). There are several options available to patients who need endoscopy. This choice can be limited if certain forms are used rather than others. Our recommendation is that all endoscopy referrals (other than 2WW referrals) be submitted on the following generic forms:

Upper GI endoscopy

Lower GI endoscopy

The above forms are accepted by Care UK Treatment Centres (Emerson's Green and Shepton Mallet ),  PRIME (Bristol) or Nuffield so that patients referred via e-referral will be offered a choice of provider (see options 2,3 and 4 below).

Please also see the Endoscopy referral matrix for each providers referral process.

The current options for referral are as follows:

1. 2 Week Wait referral - for patient with possible Upper GI cancer or lower GI cancer.

2. Care UK Treatment Centres via eReferral - Referrers must use above referral forms to access this service. See below for advice on exclusion criteria*.

3. PRIME via eReferral - PRIME will accept referrals on the above form or on their own referral form or a dictated letter with all relevant details. See their service guide for further details. See below for advice on exclusion criteria*.

4. Nuffield via eReferral – Nuffield offer a gastroscopy service only (sigmoidoscopy and colonoscopy service recently suspended). Please use the upper GI endoscopy referral form above to refer to this service.

5. UHB – Routine referrals currently suspended, unless patient does not fulfil referral criteria for alternative service in which case referrals should be submitted via ICE or directly to Queens Day Unit using their proforma. Referrals for PEG insertion/removal/replacement can also be made to Queen’s Day Unit via their upper GI proforma (see PEG insertion section below)

6. NBT - Routine referrals currently suspended, unless patient does not fulfil referral criteria for alternative service in which case referrals should be submitted via e-referral to gastroenterology or lower GI (not available via ICE unless 2WW). Requests for PEG insertions/removals/replacement in adults at NBT would be via e-referral (upper GI gastroenterology).

7.WAHT - Routine referrals are accepted. Referral forms are available as EMIS templates, following the withdrawal of MoM, for North Somerset referrers.

 

* Exclusion Criteria for community endoscopy services (exclusion criteria may vary between providers so the list below is only a guide):

  • Abusive, violent or threatening patients without a security escort
  • Under 18years of age
  • Sleep apnoea
  • Patients over 135kgs in weight
  • Patients with BMI over 40
  • ASA unstable 3, 4 or 5

For community colonoscopy patients should also be:

  • able to tolerate the bowel preparation which can be quite severe. Beware renal impairment.
  • reasonably fit to tolerate the sedation. Beware significant cardio-respiratory disease.
  • relatively mobile - during colonoscopy patients turn several times to facilitate onward movement of the scope

 

 

 

Duodenal Biopsy

EGTC and PRIME offer a duodenal biopsy service for diagnosis of coeliac disease.

Please refer using the standard upper GI endoscopy form which is accepted by both providers.

 

 

PEG Insertion

PEG insertions are done at UBHT and can be requested on ICE ( if access available at your surgery ) - search for Upper GI OG Waiting List Form.

For practices that do not have access to ICE please refer directly to Queens Day Unit on their Upper GI referral proforma.

Barium Enema Service in Weston

As from 1st May 2018, Weston General Hospital Radiology Department will no longer carry out Barium Enema examinations.  See further information on new recommendations.

FIT testing

FIT (Faecal immunochemical test) is being implemented across BNSSG in early June and can be requested in patients without rectal bleeding who are classed as at 'low risk but not no risk' of colorectal cancer.

Contact details for endoscopy providers

Referrers can contact the lead endoscopist to discuss referrals on the following numbers:

Care UK; 0117 906 1800

PRIME Endoscopy; 0117 910 3790

Nuffield; 0117 987 2727