Research paper Whichsymptomaticpatientsmeriturgent referralforcolonoscopy?AUKgeneral practiceperspective TheSouthYorkshireColorectalResearchAlliance(SYCRA) MoyezJiwaMAMDFRACGPMRCGP ProfessorofPrimaryCare,WACentreforCancerandPalliativeCare,Perth,WesternAustralia MichaelGordonMBBSBMedSci GeneralPractitioner,GleadlessMedicalCentre,Sheffield,UK PaulSkinnerFRCS ColorectalSurgeon,NorthernGeneralHospital,Sheffield,UK AkinosoOlujimiCokerFRCS ColorectalSurgeon,DoncasterRoyalInfirmary,Doncaster,UK BrigitteColwell ResearchAssociate,InstituteofGeneralPracticeandPrimaryCare(ScHARR),UniversityofSheffield,UK RowanKennyMRCGP GeneralPractitioner,StAnnsMedicalCentre,Rotherham,UK LindseyShawBA(Hons) ProjectManager MikeCampbellBAPhD ProfessorofMedicalStatistics InstituteofGeneralPracticeandPrimaryCare(ScHARR),UniversityofSheffield,UK ABSTRACT Objectives Toreviewtheassessmentofpatientsas documented in general practitioners’ (GPs’) referral lettersforurgentandroutinereferralstocolorectal surgeons. Method Wereportdataforconsecutivereferralsto colorectal surgeons in South Yorkshire, UK. Data were collected from hospital medical records and referralletters.Aquestionnairesurveyof150GPsin theregionaboutthereasonswhytheyusethecancer referralroutewasseparatelyadministeredtoawider communityofGPsinthelocality. Results Data for 432 referrals over a six-month period were available for analysis. Seventeen percent ofpatientswerereferredcontrarytonationalguide- lines. Almost 40% of referrals were sent urgently, cancerwasdiagnosedinonly2.5%ofthese.Ofthose casessenturgently,almostone-thirdhadsignificant colorectal pathologies compared to just over 11% of patients referred routinely. Of the 101 GPs respondingtothesurvey,oneineightadmittedto referring patients on the cancer fast-track referral pathway at least ‘sometimes’ in order to access an urgent appointment for some other reason. The clinicalreasonswhyoneinfivepatientswasreferred urgently could not be surmised from the details recordedintheletters. Conclusion Inmostcases,GPsappeartorecognise colorectalpathologythatrequiresurgentreferral.It may be better to prioritise specialist investigations according to clinical presentation of a variety of significantpathologiesratherthanonlyonthebasis oftheclinicalfeaturesofcancer. Keywords: colonoscopy, letter, referral Quality in Primary Care 2007;15:21–5 # 2007 Radcliffe Publishing