Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Lung - 2WW

Checked: 25-11-2022 by Rob.Adams Next Review: 25-11-2023

Service Overview

Services provided by UHBristol at the Bristol Royal Infirmary and NBT at Southmead Hospital. The services are for patients who meet the Lung Cancer Two Week Wait criteria. The service offers consultation with diagnostics and onward referral for treatment as required.

Contact details ADULT 2WW:

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to cancerservices@nhs.net

UHBW - Tel on 0117 342 7641 / 2 / 3 / 4 or email to Ubh-tr.fast-trackreferrals@nhs.net

Local Pathway

Refer to the local pathway for Suspected Lung Cancer (PDF).

Patients referred for CXR

All patients who are referred for CXR should be encouraged to attend within 72hours. CXR requests should include all relevant clinical details - particularly if they raise suspicion of malignancy. Patients should also be made aware that they may be contacted by secondary care for further tests if their CXR findings are unclear.  This is also supported by the relevant patient information leaflets for instructions on how to get direct access to radiology:

  • UHBW - Bristol - Patients need to phone and book an appointment - see booking info
  • NBT - please ask the patient to attend Southmead Hospital, Gate 18, Imaging department between 9am – 4pm, Mon-Fri, (closed Bank Holidays) to expedite the Imaging. The clinical history must include the term:Lung 2WW  Should the patient request Imaging at Cossham, Clevedon or Yate West Gate Centre they will need to call 0117 4145175. Lines are open Mon-Fri 8.45am to 4.15pm. (Closed bank holidays) and an appointment will be offered within 72 hours of calling the booking line.
  • UHBW - Weston: Place the imaging request on ICE, WGH will contact the patient once they receive the request to arrange a suitable appointment time. Please ensure that a contact number for the patient is on the request to prevent any delays to their imaging. Please advise your patient that they will receive a phone call within 48 hours.

All GP requested CXRs should be reported within 24hours.

If the CXR is suspicious for lung cancer then this will result in the patient being booked for CT (reflex CT) which will be arranged by secondary care. GPs must also submit a 2WW referral (see section below) with any relevant details at this point. For further details please see  the following document:

Direct referral to CT following abnormal CXR  - this is now active at NBT, UHB and Weston.

Patients with normal CXR but who still have red flag symptoms or signs

Up to 25% of chest X-rays can be falsely negative in lung cancer, so if the clinical suspicion is high, or there is clinical lymphadenopathy or finger clubbing, refer urgently to the fast track lung cancer service using the 2WW referral form (see Referral section below).

If advised to refer into MDT, then please submit a 2WW referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

 

The following NICE guidelines may also be helpful:

CKS Guidelines on the recognition and referral of Lung Cancer. 

Referral

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

All patients referred on this form MUST have had a chest x-ray and/or CT chest within the last 4 weeks. If no chest x-ray has been performed at time of referral please request urgently to be performed before referral.

Patients should be referred using the Suspected Lung Cancer Referral Form (word doc).

2WW Lung Cancer referrals can no longer be made to Weston General Hospital (02/12/21)

Referrals to NBT

Please note: This service is moving to a RAS at NBT from 21/11/22. Therefore, you need to select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.