RCDS pathway

Pathway examples

Health Boards were encouraged to design their own RCDS pathway (including the RCDS principles that were determined at the beginning of the process). A description of each pathway is provided below. Click on each title to view the pathway.

NHS Ayrshire & Arran

Service available since June 2021
Virtual model
21-day pathway
Haematologist Clinical Lead
Service opened to referrals from secondary care in November 2021

NHS Borders

Service available since April 2023
21-day pathway
General Practitioner as Clinical Lead

NHS Dumfries & Galloway

Service available since May 2021
7-day pathway
Hot clinics and hot reporting
General Practitioner Clinical Lead

NHS Fife

Service available since May 2021
21-day pathway
Nurse-led service
Colorectal Surgeon as Clinical Lead

NHS Forth Valley

Service available since May 2025
21-day pathway
General Practitioner as Clinical Lead

NHS Lanarkshire

Service available since April 2023
21-day pathway
Colorectal Surgeon as Clinical Lead

“In a blink of an eye I was contacted, given appointments and had my results. What a great service. My other comment would be how caring and understanding all the staff were to the fact that I was very nervous but their great people skills made it all so calming and reassuring."

RCDS patient

Referral criteria

Inclusion criteria

Vague Symptoms (as per non-specific symptoms referral criteria featuring in the clinically refreshed Scottish Referral Guidelines for Suspected Cancer):
- New unexplained weight loss (either documented 5% or more of body weight in three months or with strong clinical suspicion)
- New unexplained loss of appetite, fatigue, nausea, malaise, or bloating of four weeks or more (less if strong clinical suspicion)
- New unexplained, unexpected, or progressive pain, including bone pain, of four weeks or more
General Practitioner clinical suspicion / “gut feeling”of cancer but not indicative of specific tumour site
Patient fit enough for further investigation
RCDS bundle tests requested by General Practitioner. See section below on blood bundle results.
Does not meet criteria for site-specific pathways

Exclusion criteria:

Meets criteria for site-specific pathway
Symptoms most likely due to cancer recurrence
Patients seen by RCDS within last 3 months with no new symptoms
A serious non-cancer diagnosis is highly likely – these should be referred to the appropriate specialty
Patient too unwell to attend or likely to require acute admission

Blood bundle results

Referrals received by the RCDSs should meet the referral criteria (listed above as per Scottish Referral Guidelines for Suspected Cancer) and include blood bundle results. The following tests may be helpful in a person with non-specific symptoms where there is a concern about an underlying cancer diagnosis:

Urinalysis (for haematuria see Urological cancer guideline)
Full blood count
ESR and/or C-Reactive Protein (CRP)
Renal function (especially if considering a contrast enhanced CT)
Liver function tests
Thyroid function tests
Glycosylated haemoglobin (HBA1c)
Bone profile
Blood borne virus screen
CA125 (see Gynaecological cancer guidelines for who to test and thresholds for referral)
PSA (see Urological cancer guidelines for who to test and thresholds for referral)
Vitamin B12 levels, ferritin, and folate
Chest x-ray (see Lung and pleural cancer guidelines)

The correlation of ‘unexpected laboratory results’ to a cancer diagnosis (as mentioned in the University of Strathclyde’s evaluation), highlights the importance of ensuring that the initial tests are completed at the point of referral.

Triage and diagnostics

Timely triage of all RCDS referrals, to determine if they are appropriate for the RCDS pathway, is key. Referrals will then be accepted or re-directed as appropriate.

Any investigations required will be organised and the patient notified by the patient navigator. The essential role of radiology was clear from the evaluation and having dedicated slots supports the rapidity of the pathway.

"I like that I'm making a positive difference for patients…You know, there's more to it than just sticking them through the scanner and then telling them what it is - there's real subtleties to what's going on with some of them and by having more like a 30-minute clinic rather than a 10-minute General Practitioner appointment, I'm able to get in a bit more depth as well. So, I'm finding it professionally very engaging and satisfying as well, because I've got that bit more time with people and I feel like we're kind of getting to the root of what's going on."

RCDS healthcare professional

Multidisciplinary team (MDT) meeting

The Multidisciplinary Team (MDT) meeting or Clinical Team Meeting (CTM) is considered an important component of the RCDS particularly for complex cases requiring further investigation. The configuration of the MDT should be agreed at Health Board level.

However, considering the type of cancers identified by RCDSs, as outlined in the evaluation, is helpful in considering the expertise required within the MDT / CTM membership. The five most common cancers diagnosed through a RCDS are listed below:

Lung
Hepato-pancreatic biliary (HPB)
Lymphoma
Colorectal
Renal

The Framework for Effective Cancer Management can also offer further guidance in section '9. Effective Multidisciplinary Team (MDT) Meetings'.

"I think that's the benefit of the MDT group…we've got really good brains working behind to pick up on lots of other things…lots of non-cancer diagnoses which have massive impact on patient management as well. And that is lost with the CT Chest, Abdomen and Pelvis (CT CAP) route."