Please note that CMCA's Primary Care Resources, including information about our Primary Care Engagement Team and PCN DES, have moved to The Cancer Academy and can be accessed via this link: Primary and Community Care - The Cancer Academy .

‘FIT is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms’ - De'Souza et al., 2021


FIT stands for (Quantitative) Faecal Immunochemical Test.

FIT detects hidden or ‘occult’ blood in stool samples, using antibodies that specifically recognise human haemoglobin.

FIT is used in many screening programmes worldwide because it can detect more cancers, particularly advanced adenomas (premalignant adenomas).

There are fewer false positives and it is a sensitive enough test to assess patients who are at low risk of developing colorectal cancer.

From April 2023, the suspected Lower Gastrointestinal (LGI) cancer referral pathway will be changing for GP practices which refer patients in to the following trusts:

April 2023:

  • St Helens & Knowsley Teaching Hospitals NHS Foundation Trust
  • Warrington & Halton NHS Foundation Trust
  • East Cheshire NHS Trust
  • Mid Cheshire Hospitals NHS Foundation Trust
  • Wirral University Teaching Hospital NHS Foundation Trust

May 2023:

  • Countess of Chester NHS Foundation Trust
  • Liverpool University Hospitals NHS Foundation Trust
  • Southport & Ormskirk NHS Trust

This pathway REPLACES the current NG12 and DG30 guidance in your area and affects all patients aged 18 years and above with suspected LGI cancers.

This revised pathway includes expanded use of FIT, aligning to guidance from the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain & Ireland (ACPGBI), which is supported by NHSE and accredited by NICE.

It is also underpinned by compelling evidence to support the use of FIT in conjunction with relevant blood tests, history and clinical examination to determine the appropriate referral or management pathway, improving the detection of cancers and improve patient experience.

Ash Bassi photo.jpg


"FIT tests has high sensitivity and specificity and may be an effective triage tool when considering whether to perform investigations in patients presenting with lower GI symptoms. IT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for colorectal cancer."

- Dr Ash Bassi, Cheshire and Merseyside FIT Clinical Lead; NHS England Endoscopy Advisor, North West

Debbie Harvey photo.jpg


"We know that FIT is superior to symptoms in detecting people with colorectal cancer. We believe that this revised pathway which includes all of those 18yrs and above, incorporates FIT results and unexplained IDA will help improve cancer outcomes for our population in Cheshire and Merseyside."

- Dr Debbie Harvey, CMCA GP Lead and Cheshire and Merseyside FIT Primary Care Lead


New guidance and supporting materials

Please go to The Cancer Academy website for the up-to-date guidance and other useful resources like the new Urgent Suspected Lower GI Cancer Referral Form:

Our video, below, for clinicians explains how the use of FIT and referral practice for suspected Lower GI cancers is changing in Cheshire and Merseyside.

Watch the video presented by Dr Debbie Harvey, CMCA GP Cancer Lead, below, or via this YouTube link:

The video above is also available with subtitles in the following languages:


Patient information

Patient letter

Patient information letter: This can be given to patients by primary care clinicians to explain why they are being asked for the test and the importance of getting their blood tests done as well. It is important to note that there may be slight local variations.

Patient information letter

An Easy Read version is available here. The letter is also available in a Braille version, which can be requested by emailing:

This leaflet is also available in the following translations:


Patient information leaflets for completion of FIT

Patient leaflets: These have been produced to assist patients in completing their FIT test. They can be used, shared and distributed around Cheshire and Merseyside. Primary care may wish to share the links with their patients via text messages to support them in completing the FIT.

Patient instruction leaflet

Patient instruction leaflet (for patients referred to Liverpool University Hospitals Foundation Trust)

An Easy Read version is available here. The leaflet is also available in a Braille version, which can be requested by emailing:

The Cheshire and Merseyside information leaflet is also available in the following translations: