Primary Care Update – Multidisciplinary Rapid Access Diagnostic Clinic (MRADC) at Barts Health – November 2023

We are writing to update you on referring to the MRADC clinic (also known as rapid diagnostic clinic, RDC) at Barts Health. We apologise for the confusion in our last communications which informed GPs that this clinic was paused.  

 The MRADC clinic is fully open, all patients referred into the service are being clinically assessed and seen.  We have received 209 referrals since 17 August, of which:  

• 183 patients were seen under the RDC umbrella (RDC clinic and RLH colorectal) 
• 6 patients were redirected internally to another clinic 
• 8 patients were redirected to BHRUT as their local RDC 

 The service did face severe pressures due to staffing issues, but between September to November we have been recruiting more members to our team so we can provide a better service to you and our patients.  

 Over the past two months a clinical lead, 12-hour GP time, a respiratory consultant and sarcoma advanced nurse practitioner have all been recruited to the team. A substantive medical secretary and two more advanced nurse practitioners will also join us before the end of November.  

 More team members mean we can see more patients. Hiring the staff listed above will result in an extra 72 patient appointments each month, increasing to 120 at the end of December when the second advanced nurse practitioner starts.  

 On average, we see around 100 new patients each month, which means by the end of December will be able to meet this expected demand. The team are also reviewing the number of follow-up appointments patients may require if a cancer is not diagnosed. 

 To ensure we continue to improve our service, a quality review has been commissioned by the cancer alliance and the ICB. This review will be completed by the end of November.  

Referring to clinics 

 Please refer your patients >18y with non-specific symptoms (NSS) concerning for malignancy in the usual way using the MRADC referral form found on EMIS in resource publisher or you can download a copy here. 

 Please ensure that patients have had all the appropriate investigations prior to referral (such as blood tests, FIT, CXR, USS – see referral form for more details) 

 When you send a referral to us the following process is enacted: 

• Each referral is triaged by our RDC clinical lead and service manager  
• There are currently no diverts to other hospitals in Barts Health  

 With the recent changes to the National Cancer Waiting Times Guidance, we have changed the clinic type on eRS to 2WW Non-Specific Symptoms (NSS). From 1^st July 2023 patients referred on the NSS pathway are included in the 28 FDS standard, which is diagnosis or ruling out of cancer within 28 days of referral. 

How to refer to the MRADC (RDC) 

 Patients meeting the following criteria: –  

• NSS or vague symptoms that do not fit an existing Urgent Suspected Cancer (USC) pathway  

NSS Referrals to the MRADC clinic can be made through e-RS by selecting: 2WW – Multidisciplinary Rapid Access Diagnostic RAS Clinic (RLH) – found under clinic type 2WW Non-specific symptoms (screenshot below) 

 Patients who have a basic imaging result suggestive of malignancy of unknown origin or primary site can be referred using the MRADC referral form. These patients will be seen and clinically assessed in the MRADC clinic.  

 Referrals meeting the above malignancy or unknown origin, or primary site can be made through e-RS by selecting: 2WW – Cancer of Unknown Primary – RAS (RLH) – found under clinic type 2WW Cancer of Unknown Primary (screenshot below). Both NSS and CUP referrals filter into the same service. 

We are writing to update you on referring to the MRADC clinic (also known as rapid diagnostic clinic, RDC) at Barts Health. We apologise for the confusion in our last communications which informed GPs that this clinic was paused.  

 The MRADC clinic is fully open, all patients referred into the service are being clinically assessed and seen.  We have received 209 referrals since 17 August, of which:  

• 183 patients were seen under the RDC umbrella (RDC clinic and RLH colorectal) 
• 6 patients were redirected internally to another clinic 
• 8 patients were redirected to BHRUT as their local RDC 

 The service did face severe pressures due to staffing issues, but between September to November we have been recruiting more members to our team so we can provide a better service to you and our patients.  

 Over the past two months a clinical lead, 12-hour GP time, a respiratory consultant and sarcoma advanced nurse practitioner have all been recruited to the team. A substantive medical secretary and two more advanced nurse practitioners will also join us before the end of November.  

 More team members mean we can see more patients. Hiring the staff listed above will result in an extra 72 patient appointments each month, increasing to 120 at the end of December when the second advanced nurse practitioner starts.  

 On average, we see around 100 new patients each month, which means by the end of December will be able to meet this expected demand. The team are also reviewing the number of follow-up appointments patients may require if a cancer is not diagnosed. 

 To ensure we continue to improve our service, a quality review has been commissioned by the cancer alliance and the ICB. This review will be completed by the end of November.  

Referring to clinics 

 Please refer your patients >18y with non-specific symptoms (NSS) concerning for malignancy in the usual way using the MRADC referral form found on EMIS in resource publisher or you can download a copy here. 

 Please ensure that patients have had all the appropriate investigations prior to referral (such as blood tests, FIT, CXR, USS – see referral form for more details) 

 When you send a referral to us the following process is enacted: 

• Each referral is triaged by our RDC clinical lead and service manager  
• There are currently no diverts to other hospitals in Barts Health  

 With the recent changes to the National Cancer Waiting Times Guidance, we have changed the clinic type on eRS to 2WW Non-Specific Symptoms (NSS). From 1^st July 2023 patients referred on the NSS pathway are included in the 28 FDS standard, which is diagnosis or ruling out of cancer within 28 days of referral. 

How to refer to the MRADC (RDC) 

 Patients meeting the following criteria: –  

• NSS or vague symptoms that do not fit an existing Urgent Suspected Cancer (USC) pathway  

NSS Referrals to the MRADC clinic can be made through e-RS by selecting: 2WW – Multidisciplinary Rapid Access Diagnostic RAS Clinic (RLH) – found under clinic type 2WW Non-specific symptoms (screenshot below) 

 Patients who have a basic imaging result suggestive of malignancy of unknown origin or primary site can be referred using the MRADC referral form. These patients will be seen and clinically assessed in the MRADC clinic.  

 Referrals meeting the above malignancy or unknown origin, or primary site can be made through e-RS by selecting: 2WW – Cancer of Unknown Primary – RAS (RLH) – found under clinic type 2WW Cancer of Unknown Primary (screenshot below). Both NSS and CUP referrals filter into the same service. 

A guide to abbreviations

Further help

If you have any questions about the service, please contact us on 07715 805 112, Monday to Friday, 9am to 5pm or by emailing bhnt.rapidaccessdiagnosticclinic@nhs.net