Rapid Access Chest Pain Clinics (RACPC) within BNSSG can be found at:
The initial aim of assessment of a patient with chest pain is to identify, or exclude a serious cause which needs immediate hospital admission, such as acute coronary syndrome (see red flags below).
If hospital admission is not required then a detailed history and examination should be undertaken and an ecg performed. Other investigations should be carried out based on suspected cause.
Please also see the following guidelines:
Purpose of RACPC
The RACPC provides a face-to-face clinic, led by a team of specialist nurses (some are non-medical prescribers), and occasionally doctors. The purpose of the service is to provide rapid assessment of patients with suspected stable cardiac chest pain (e.g. angina or atypical angina). They aim to support early diagnosis and management and identify those who may benefit from urgent investigation, treatment and intervention to prevent myocardial injury.
They also see recurrent/worsening angina symptoms in known ischaemic heart disease patients who have been medically optimised by primary care and are not under follow up by a cardiologist.
Please note:
Referrals to a Rapid Access Chest Pain Clinic should be reserved for patients with:
⚠️ RACPCs are under significant pressure. Please use the BNSSG RACP referral form (template available in EMIS) and check the criteria carefully.
Exclusions
Please do not refer the following patients to RACPC:
Alternative referral pathways
RACPC should not be used for the rapid assessment of breathlessness or palpitations in the absence of chest pain. Please see below for alternative outpatient clinics:
Clinic |
Intended for patients with |
Access via |
Palpitations |
Referral via e-RS |
|
New onset heart failure |
Referral via e-RS |
|
Any new respiratory symptom |
Referral via e-RS |
Refer immediately to hospital (via 999) if any of the following are present:
👉 Response to GTN should not be used to rule in/out ACS.
CKS has advice on Which People With Chest Pain Should Be Admitted to Hospital: Scenario: Management | Management | Chest pain | CKS | NICE
Immediate Assessment
If a patient presents in general practice with current or recent history (within previous 12 hours) of chest pain suspected to be due to ACS, then call 999. Take an ECG if this is possible.
If the ECG excludes STEMI then during normal working hours, please also call the Weekday IUC Professional line on 0117 2449283 (open Monday to Friday 08:00 - 18:30 - not weekends and bank holidays) as patients without STEMI can often be managed as medically expected which helps streamline their route through the hospital.
Other causes of chest pain
Other indications for immediate admission to hospital can be found in the Management of Chest Pain section of the CKS guidelines.
Patients should have a physical examination of their cardiovascular system and findings should be included in the referral including:
The following investigations should be considered (but should not delay referral)
Echocardiogram – this is not a requirement for referral to RACPC but please include results if this has been done previously.
Upload referrals directly via e-RS to RACPC at your chosen site (do not use the Referral Service – delays may occur).
Use the BNSSG RACP referral form (available as a template in EMIS). It's use is not mandatory, however if not used please ensure the required information is included in a referral to assist the cardiology teams in their triage and assessment processes
Include:
📞 Patients will be contacted to arrange their appointment – ensure their contact information is current.
❗If a referral is rejected, you’ll receive a notification via e-RS.
Contact details for urgent additional queries:
RUH Bath also has a RACPC although referral criteria may differ.
Refer via eRS using the RUH RACP referral form available on the RUH website and in EMIS. Please submit directly via eRS and not via the Referral Service.
(1) Chest pain | Health topics A to Z | CKS | NICE
(2) Angina | Health topics A to Z | CKS | NICE
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
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