Urology Department, Box 43 Cambridge University Hospitals NHS Foundation Trust

Dear GP

Please advise your patient that they are being referred on a 2 week pathway and they will be asked to attend an appointment within this 2 week timeframe.

Please ensure that the patient receives a copy of the patient leaflet

Why have I been referred urgently to hospital?

We anticipate that the majority of appointments will be referred via Choose and Book.

If you are referring outside Choose and Book, please give this page to your patient so they can phone and arrange their own clinic appointment.

Dear Patient

Your GP has asked for you to have an urgent appointment within two weeks.

Attending this appointment within two weeks is very important. Please read the leaflet: Why have I been referred urgently to hospital?

To arrange your fast-track Urology appointment please phone 01223 256269 between 1400 to 1630 hrs on the next working day after your visit to your GP.

You will be offered an appointment within 14 days of receipt of your GP’s referral.

Thank you

Addenbrooke’s Fast-Track Urology Clinic

For your diary/calendar:

Details of your Urology clinic appointment (as arranged by phone - see above):

Date: Time:
Fast-track referral proforma: Suspected urology cancer

Please refer via Choose and Book or fax to: 01223 216573

Urology, Box 43

Tel: 01223 216575 Hills Road, Cambridge CB2 0QQ

I am sending an accompanying letter


Patient's details:

Surname: NHS No:

Forename: Hosp No:

Address: Date of birth:

Daytime Tel:

Evening Tel:

Mobile Tel:

Postcode: Language of choice:

Communication/understanding difficulties


Referring GP's details (please print or stamp):

Name:

Surgery Address:

Surgery Tel: Surgery Fax:

GP Signature: Referral Date:

NB: Department of Health urgent referral guidelines on page 3

Suspected Prostate Cancer
If UTI present treat and repeat PSA after 6 weeks. Only refer if PSA remains elevated
Refer if either
Raised age related PSA
PSA (ng/ml or µg/l)
Age / Maximum PSA
40-49 / 2.2
50-59 / 3.1
60-69 / 4.0
> 70 / 5.8
Lower urinary tract symptoms
Bone pain
Abnormal rectal examination
nodule hard fixed /
Suspected Incidental Renal Cancer
Incidental renal mass on imaging
(Please fax copy of imaging report)
Serum Creatinine ………….….. Umol/l

Patient's name: Date of birth: (for continuation sheet)

Suspected Testicular Cancer
Swelling in the body of the testis /
Suspected Penile Cancer
Penile ulcer/lump/lesion
Haematuria – please refer to the clinical policy before referrral on http://www.cambsphn.nhs.uk/CCPF/PHPolicies.aspx
Referral to Haematuria Clinic: only if one of the following is present:
Patient at any age with visible haematuria (VH).
Patient at any age with symptomatic non-visible haematuria (s-NVH) with persistent irritative lower urinary tract symptoms (e.g. hesitancy, urgency, dysuria, suprapubic pain); and UTI has been excluded.
Patient more than 50 years age with persistent asymptomatic non-visible haematuria (a-NVH), i.e. 2 out of 3 isolated dipsticks done at weekly intervals are positive for NVH.
Patients with haematuria not fulfilling the above criteria, e.g. with renal colic or nephrological symptoms, should be referred to the appropriate pathway.
Non-visible haematuria (NVH) is defined as ³ 1+ on dipstick urinalysis. Trace haematuria is considered negative. MSU is not needed to assess for haematuria but may be used to exclude UTI.
Prior haematuria assessment at Addenbrooke's? If yes, when? …../…../…..
Warfarin
Aspirin
Allergies
Heart valve disease/
prosthesis
(i.e. procedure-related
endocarditis risk) / Other drugs
Other notable history
If yes, please provide details / ………..………………………...…
………..………………………...…
………..………………………...…
………..………………………...…
………..………………………...…
………..………………………...…
I am faxing a letter with additional background (at your discretion)
If yes, please tick if a fast-track proforma has already been faxed

(DoH Guidelines overleaf)

DEPARTMENT of HEALTH Guidelines for Urgent Referral of Suspected Urological Cancers:

·  Macroscopic haematuria in adults.

·  Microscopic haematuria in adults over 50 years.

·  Swellings in the body of the testis.

·  Palpable renal masses.

·  Solid renal masses found on imaging.

·  An elevated age specific PSA (ng/ml or µg/L) in men with a ten year life expectancy.

Age / Maximum PSA
40-49 / 2.2
50-59 / 3.1
60-69 / 4.0
> 70 / 5.8

·  A high PSA (> 20ng/ml or µg/L) in men with a clinically malignant prostate or bone pain.

·  Any suspected penile cancer.

Addenbrooke's NHS Trust Suspected Prostate Cancer Management Pathways

Please use the jointly agreed Urology Fast-track referral proforma for all referrals.

Subsequent management within the Urology Department

PSA criteria

·  < 15: 2-4/52 One-stop Prostate-Biopsy Clinic

·  15 – 250: 2/52 Prostate Diagnostic Clinic/One-stop Prostate-Biopsy Clinic

·  > 250: Urgent bone scan, 2/52 OPD, possibly without biopsy

NB: If PSA > 100: Please prescribe an anti-androgen at point of referral

Digital Rectal Examination (DRE) criteria

·  nodule or hard/fixed prostate: One-stop Prostate-Biopsy Clinic: urgency
dependent on PSA

NB: if referred on grounds of DRE: Please send blood for a PSA at the point of
referral.

1 January 2013 Instruction sheet, 2-page form, 1 page notes and patient leaflet

File: in correspondence section of Medical Records

Urology Department, Box 43 Cambridge University Hospitals NHS Foundation Trust


NHS Cambridgeshire Patient Leaflet

A leaflet explaining

the urgent two week

referral system


WHY HAVE I BEEN REFERRED TO HOSPITAL?

Your General Practitioner (GP) or dentist has asked for you to have an urgent hospital appointment within two weeks.

The two week appointment system was introduced so that any patient with symptoms that might indicate cancer, or a serious condition, could be seen by a specialist as quickly as possible.

Attending this appointment within two weeks is very important and will allow you to benefit from:

·  in most cases, early reassurance that cancer has not been diagnosed or,

·  an early diagnosis and earlier access to treatment, which is shown to improve health outcomes

DOES THIS MEAN I HAVE CANCER?

No it does not. The majority of patients referred under the two week appointment system do not have cancer but may have another condition requiring hospital diagnosis and treatment.

WHY HAS THE GP REFERRED ME?

GPs diagnose and treat many illnesses themselves. Occasionally they need to arrange for you to see a specialist hospital doctor. This could be for a number of reasons, such as:

·  your symptoms need further investigation

·  the treatment already prescribed has not been effective

·  investigations your GP has already arranged have shown some abnormal results

There are national referral guidelines for your GP to use when making a decision about whether it is appropriate to refer you for an appointment within two weeks.

1 January 2013 Instruction sheet, 2-page form, 1 page notes and patient leaflet

File: in correspondence section of Medical Records

Urology Department, Box 43 Cambridge University Hospitals NHS Foundation Trust

WHAT SYMPTOMS MIGHT NEED AN URGENT REFERRAL?

·  a lump that does not go away

·  a change in the size, shape or colour of a mole

·  abnormal bleeding

·  a change in bowel or bladder habits including increased frequency

·  persistent tiredness and/or unexplained weight loss

WILL I NEED ANY TESTS?

You may require specialised tests. These may take place either before or during your first hospital appointment. This will help the specialist understand the cause of your symptoms.

WHAT DO I NEED TO DO?

·  Make sure your GP has your correct address and telephone number, including mobile number

·  If you do not have a confirmed appointment within one week of seeing your GP, contact your GP practice

·  Let the hospital know immediately if you are unable to attend your appointment, so the time can be offered to someone else

·  It is important you arrange an alternative appointment when cancelling

·  At your first hospital appointment you will be given more information about what will happen next

·  You may take someone with you to your appointment if you want to

1 January 2013 Instruction sheet, 2-page form, 1 page notes and patient leaflet

File: in correspondence section of Medical Records

Urology Department, Box 43 Cambridge University Hospitals NHS Foundation Trust

CONTACT DETAILS -TWO WEEK WAIT REFERRAL OFFICES:

·  Addenbrooke’s Hospital – please see your referral letter for relevant contact telephone number

·  Hinchingbrooke Hospital – 01480 363595

·  Peterborough Hospital – 01733 874191

·  Queen Elizabeth Hospital – 01553 613626

More information about the two week appointment system and other information is available at:

·  www.nhsdirect.nhs.uk

·  www.nice.org.uk

1 January 2013 Instruction sheet, 2-page form, 1 page notes and patient leaflet

File: in correspondence section of Medical Records