Rapid Access Patient Investigation and Diagnosis Portal (RAPID-P) Cowgill Medical Practice

Rapid Access Patient Investigation and Diagnosis Portal (RAPID-P) is a model of practice developed and piloted in primary care by Westcliffe Health Innovations and Oberoi Consulting.

In June 2015, the National Institute for Health and Care Excellence (NICE) advised a standard for offering urgent and direct access to endoscopy in two weeks and definitive diagnosis within four weeks. RAPID-P is designed to successfully implement this for upper gastrointestinal (GI) cancers. Each patient completes a secure online self-triage questionnaire, which grades responses to answers with either:

• direct straight to test at an endoscopy clinic
• straight to test at an urgent specialist outpatient clinic with a consultant gastroenterologist
• a prompt GP appointment.

This process bypasses an initial GP appointment, as a physical examination adds nothing to decision making for this condition. Plan-Do-Study-Act testing was conducted to ensure safety and acceptability to patients.

From January to May 2017, 69 patients with upper gastrointestinal symptoms completed the questionnaire. Early results taken from tracking a small sample of these indicate those identified with:

• red, urgent referral, were referred and seen within seven days
• high amber, direct referral recommendation, were seen within 14-25 days, with 50% seen within 14 days.

All patients received a confirmed diagnosis and initiated an appropriate treatment pathway, and all referrals were within NICE’s recommended time and faster in <50% of cases. The intervention is now standard care across the participating practices.