The Faecal Immunochemical Test (FIT) is an important test in helping to improve the diagnosis of colorectal cancer.
The test looks for microscopic amounts of blood in a stool sample collected at home by the patient using a special FIT collection kit. This kit can be given out by the GP or medical practice administration staff following a consultation.
Traces of blood in the stool can be caused by other medical conditions and doesn’t necessarily mean the patient has cancer. But if it is cancer, finding it at an early stage means there are more treatment options available.
In July 2022 the British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain & Ireland (ACPGBI) published a NICE accredited joint guideline on use of FIT in patients with signs or symptoms of colorectal cancer.
The recommendations from these guidelines included:
- the use of FIT in primary care for patients presenting with all NG12 suspected colorectal cancer symptoms (excluding anal/rectal mass or anal ulceration), and
- those patients with a FIT of fHb <10 10μg Hb/g, a normal full blood count and no ongoing clinical concerns are not referred on a lower GI urgent cancer pathway, and are instead managed in primary care or referred on an alternative pathway.
In October 2022 NHSE letters to health system leads on the use of FIT in the LGI pathway asked for the recommendations in the BSG/ACPGBI guidance to be implemented in full.
In August 2023 NICE Diagnostic Guidance on FIT and updated NG12 Suspected Cancer Referral Guidelines were published.
- FIT should be used to guide referral on a colorectal suspected cancer pathway and symptomatic patients should be referred if they have a FIT result of at least 10 µg Hb/g. However referral should not be excluded on the basis of FIT alone IF there is strong clinical concern of cancer.
- Patients with a rectal or anal mass or anal ulceration do not need to be offered FIT before referral.
What has changed?
In line with the evidence, from 9th January 2023 the colorectal cancer pathways are changing throughout Wessex. This letter circulated to primary care teams on 6th January outlines the changes.
Please also view this webinar held on 11th January 2023 to introduce the new pathway and the clinical implications.
Some areas have adapted the flow chart slightly to reflect local variation, see below:
- The LGI Fast Track referral form has been updated in line with national guidance making FIT>10 the main referral criterion unless the patient has an unexplained abdominal, rectal or anal mass/ulceration.
The new form retains the ability for referral where there is concern about colorectal cancer even if FIT < 10 or patient is unable or unwilling to do a FIT test, or the result is delayed.
The updated LGI Urgent Suspected Cancer referral form is now available on GP systems. For reference, and to check you are using the correct version, please see a copy here.
- Provision of a secondary care FIT < 10 pathway that Primary Care can refer into for patients with NG12 symptoms but who have FIT <10 and the GP is not happy to safety net in Primary Care.
Please see the section below for details.
Information for your patients on how to complete a FIT test can be found on the Cancer Matters Wessex website
Testing for blood in your poo using the FIT test – Cancer Matters Wessex
There is also information available for patients who are being referred on the FIT <10 pathway
Colorectal Follow Up Pathway (FIT less than 10) – Cancer Matters Wessex
Primary care teams will need to have systems in place to make sure patients can rapidly have blood tests and FIT testing, and to safety net receipt of the results.
- Coding the provision of FIT, running regular reports and use of scheduled tasks and text message reminders (e.g. AccuRx) can all help.
- Ensure wider team members including reception staff are familiar with the test and process, and encourage patients to return their sample as quickly as possible.
We have produced some safety netting guidance to help you consider when safety netting will be needed in the new pathway and tips for how to do this. Please also see examples below of safety netting protocols and templates from other Wessex practices, that you can adapt to suit your needs:
- FIT Protocol for Lower GI Referrals – Southampton North PCN
- FIT Protocol – Mid Dorset PCN
- FIT Flow Chart – Mid Dorset PCN
- FIT Information Slip – Mid Dorset PCN – to be stapled to the outside of the FIT kit envelope before handing to patients
The Cancer Research UK Safety Netting Hub also has a range of resources to support primary care with safety netting.
You can use the following codes to record the provision of FIT:
- Provision of FIT kit – Y36a6 (READ code) / 149421000000109 (SNOMED
- FIT kit declined – Y35d6 (READ Code) 149441000000102 (SNOMED)
The FIT result should auto-generate the following code in the patient record. This is the code that achievement of the IIF indicator CAN-01 will be based on.
- FIT result received – Xaf0H (READ Code) / 1049361000000101 (SNOMED)
We are aware that in some parts of Wessex the result was not coding last year but we believe this has now been resolved. If you have any concerns about this please get in touch via wessexcanceralliance@wca.uhs.nhs.uk