Direct-access imaging referrals - RAG clinical prioritisation

NCL imaging departments have agreed on a set of standardised imaging prioritisation categories. 

These must be applied whether that GP is making a referral to a NHS service provider or the independent sector. 

GPs can refer direct to hospitals for urgent diagnostics and are encouraged to consider this instead of 2WW. 

Direct-access imaging services Suspected cancer referral form

Clinicians can request the following direct-access investigations for suspected cancer at any provider trust using a single referral form.

Providers

University College London Hospitals, Royal Free London, North Middlesex University Hospital, Whittington Health

Imaging modalities

• Abdominal USS (Suspected Gall bladder or Liver Cancer) 
• MRI head/ CT head (if MR contraindicated e.g. pacemaker) (Suspected Brain and CNS Cancer)
• CT abdomen (Suspected Pancreatic Cancer)
• CXR (Chest x-ray for Suspected Lung Cancer)
• Pelvic USS (Suspected Endometrial Cancer) (Royal Free, North Middlesex, Whittington Hospital only. For Gynae USS at UCLH please use the 2WW pathway)
• Testicular USS (Suspected Testicular Cancer)

How to refer

EMIS form: Urgent Direct Access Imaging Request Form (adult and paed) Suspected Cancer – NCL

Where to find the form

• NCL: NCL Global Documents > Imaging  

Echocardiography triage resource (British Society of Echocardiography)

Transthoracic echocardiography is an essential test in the evaluation of patients with suspected structural and functional cardiac conditions. When used appropriately it facilitates rapid diagnosis and timely intervention for patients. The British Society of Echocardiography has previously issued detailed guidance, aimed at hospital and specialist referrers, regarding the indications for, and optimal timing of, outpatient, inpatient, and critical care transthoracic echocardiography. 

However, the society also recognises that very often the most useful information in primary care is to know the clinical conditions in which transthoracic echocardiography is not routinely indicated at the time of initial clinical contact. These conditions are grouped by symptom or clinical finding in a primary care triaging poster for rapid reference by GPs for use in primary care settings. This guidance is not intended to override clinical judgment in individual cases and has chiefly been created to support situations where clinical judgement favours avoiding further investigation. 

Primary care triaging poster: Conditions in which an echocardiogram has low clinical yield from primary care (BSE, April 2021)