Faecal Immunochemical Test (FIT)

The Faecal Immunochemical Testing (FIT) is a test which analyses poo samples to identify possible signs of bowel disease, including bowel cancer. FIT was introduced for use in primary care in symptomatic patients since 2019. It was also implemented across London to assist with triaging bowel cancer referrals during the COVID-19 pandemic to ease the burden on stretched specialist teams.

Comprehensive use of FIT in NG12 patients is critical to improving bowel cancer survival in England, ensuring patients on the lower GI pathway can be diagnosed promptly and using our available colonoscopy capacity in the most effective way. In July 2022, the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain and Ireland (ACPGBI) published guidance recommending the use of FIT to triage patients presenting in primary and secondary care with signs or symptoms of suspected colorectal cancer.

• FIT in Primary Care
• FIT in Secondary Care
• FIT Admin Pathway

FIT in Primary Care

Below you will find resources developed for primary care teams:

TCST funded GatewayC to produce a collection of on-demand resources covering the role of FIT and tips for appropriate use with symptomatic patients, suitable for primary care clinicians and administrators

• The resources can be accessed here.

Two webinars discussing the role of FIT and how primary care administrative staff and clinicians can best support patients took place in 2023. Both webinars were produced by GatewayC, supported by TCST, NHS England and the Greater Manchester Cancer Alliance Early Diagnosis Team. The webinars are available to view on demand on the links below.

• FIT webinar for primary care administrative staff
• FIT webinar for primary care professionals

TCST has created a poster for GP practice staff to support them in explaining to patients the correct way to complete and return a FIT. The purpose of the poster is to act as step-by-step guide for staff when speaking to patients required to complete a FIT, enabling staff to give clear directions to patients so that samples are correctly collected and labels filled in and returned quickly to the surgery, which will in turn reduce the number of FITs being rejected. The poster has been designed with input and support from professionals within the London cancer community including the Cancer Alliances and Cancer Research UK.

• The FIT Admin Pathway Testing Poster can be found here.

FIT in Secondary Care

A project to promote the use of FIT in hospital emergency departments is being trialled within north east London. Whilst FIT was introduced for use in primary care for symptomatic patients in 2019, it is not currently routinely available in secondary care.  The aim of the project is to support the earlier diagnosis of patients with lower gastrointestinal (GI) red flag symptoms indicative of possible bowel cancer.

The pilot project will improve hospital clinicians’ access to FIT to allow testing of appropriate patients who present in urgent care departments in hospitals. The aim is to develop and test pathways incorporating FIT in secondary care to improve the clinical evaluation and triage of patients for investigation of lower GI disease, identify low risk symptomatic patients to determine need for endoscopy or other investigation and, ultimately, reduce time to diagnosis.

The pilot project is expected to run for between six to eight months across three sites in north east London. These are: the Urgent Care Departments at Whipps Cross Hospital and Queen’s Hospital (the urgent care setting at Queen’s Hospital is also known as the Partnership of East London Cooperatives (PELC)). The work will be supported by senior clinical ED champions, colo-rectal cancer clinical specialists and dedicated navigators.

The project is funded by the NHS England National Cancer Team and delivered by our team at TCST.

Below are some useful resources relating to the FIT pilot:

• FIT in Secondary Care pilot: video for clinicians.
• FIT in Secondary Care North East London pilot project brief.
• FIT in Secondary Care
• FIT in Secondary Care: Patient Information Leaflets

National Cancer Diagnosis Audit

The National Cancer Diagnosis Audit (NCDA) aims to collect in-depth data to further understand the patient pathway through primary care to the diagnosis of cancer. Data can be used alongside cancer registration and secondary care health data to further understand pathways to cancer diagnosis locally, regionally, or nationally. Each participating practice receives a report on their own NCDA results, which can be used to drive quality improvement projects and fulfil this requirement in the Primary Care Networks Direct Enhanced Service.

In July 2019, the Transforming Cancer Services Team (TCST) – Early Diagnosis Team developed a funded incentive scheme for participating practices in London. Over 450 practices took part in the scheme, marking an unprecedented uptake in audited cancer cases for 2018. The funding scheme has now closed but practices can still complete their audits using the training and information provided on the CRUK dedicated NCDA page. Practices in London can also request support from their local CRUK facilitator.

CRUK facilitators and GP cancer leads (available to some areas of London) are an excellent resource for practices to get help with running audits, accessing, and interpreting data and developing cancer quality improvement projects.

Findings across the region reveal patients are diagnosed younger with cancer compared with England.  Also, whilst patients in London are referred quicker to a first appointment for cancer symptoms it takes longer for them to receive a diagnostic test.  For more detail on the London findings please download the London NCDA presentation and report:

• NCDA London Summary Presentation
• NCDA final London feedback report