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Which symptomatic patients merit urgent referral for colonoscopy? A UK general practice perspective

Moyez Jiwa , Michael Gordon , Paul Skinner , Akinoso Olujimi Coker , Rowan Kenny , Lindsey Shaw , Mike Campbell

Objectives To review the assessment of patients as documented in general practitioners’ (GPs’) referral letters for urgent and routine referrals to colorectal surgeons.Method We report data for consecutive referrals to colorectal surgeons in South Yorkshire, UK. Data were collected from hospital medical records and referral letters. A questionnaire survey of 150 GPs in the region about the reasonswhy they use the cancer referral route was separately administered to awider community of GPs in the locality.Results Data for 432 referrals over a six-month period were available for analysis. Seventeen percent of patients were referred contrary to national guidelines. Almost 40% of referrals were sent urgently, cancerwas diagnosed in only 2.5% of these. Of those cases sent urgently, almost one-third had significant colorectal pathologies compared to just over 11% of patients referred routinely. Of the 101 GPs responding to the survey, one in eight admitted to referring patients on the cancer fast-track referral pathway at least ‘sometimes’ in order to access an urgent appointment for some other reason. The clinical reasons why one in five patients was referred urgently could not be surmised from the details recorded in the letters. Conclusion In most cases, GPs appear to recognise colorectal pathology that requires urgent referral. It may be better to prioritise specialist investigations according to clinical presentation of a variety of significant pathologies rather than only on the basis of the clinical features of cancer.