Understanding the FIT for Symptomatic Patients Pathway
As a GP who moved to New Zealand from the UK, one of the biggest challenges I noticed was managing patients with bowel symptoms that were concerning, but did not meet the threshold for direct colonoscopy referral. These were often patients where my clinical instinct told me further assessment was needed, and indeed the patients wanted and were expecting further investigation, but the available referral pathways did not always provide a clear or timely route to investigation.
Many people are surprised to hear that there are specific criteria that usually need to be met before a patient can be referred directly for a colonoscopy. These thresholds can feel high, particularly for younger patients. For example, some patients under 50 may need a persistent change in bowel habit combined with rectal bleeding, or other defined features before they meet the criteria for urgent colonoscopy referral.
This is not because the health system, hospital doctors or GPs are trying to be restrictive or difficult. It is because colonoscopy is a limited resource, and the referral criteria exist to help manage demand and prioritise those at highest risk.
The difficulty for me as a GP is the group of patients who sit in the middle. They may not meet the threshold for immediate colonoscopy, but they still have symptoms that need to be taken seriously. Until now, the tools available to help risk assess these patients have been limited (or non existent).
That is why the new FIT for symptomatic pathway is such an important development. It gives GPs an evidence based tool to help assess patients with potential bowel cancer symptoms, identify those who may need further investigation, and support safer decision making.
What the New FIT for Symptomatic Pathway Means for Kiwis
Health New Zealand has announced a new FIT for Symptomatic pathway, designed to help assess people who have bowel symptoms and may need further investigation.
FIT stands for faecal immunochemical test. It is a simple stool test that looks for tiny traces of blood in a bowel motion, which can sometimes be an early warning sign of bowel cancer or other bowel conditions.
It is important to be clear that this new pathway is for people with symptoms. It is not the same as bowel screening.
Bowel screening is for people who do not have symptoms. The FIT for Symptomatic pathway is for people who do have bowel symptoms and have been assessed by their GP or healthcare provider.
How to get a FIT Test through your GP in NZ
The new pathway means that once a patient presents to their GP with symptoms concerning for colorectal cancer, they can be referred to the hospital system. This referral will then be triaged by a doctor at the hospital and will either be referred directly for colonoscopy, offered a FIT test or 'rejected'.
Some people with 'high risk' symptoms such as a combination of a change in bowel habit, weight loss, and rectal bleeding will still need direct referral for colonoscopy or specialist assessment, depending on their symptoms and overall risk.
However now patients with bowel symptoms will be offered a FIT test as part of their management. A positive FIT result may allow that patient to be referred directly for a publicly funded colonoscopy, helping to prioritise those at higher risk. If the FIT result is negative, the patient may be returned to the care of their GP, with advice to monitor their symptoms and seek further review if symptoms persist, worsen, or new symptoms develop.
This is a positive step for bowel cancer detection in New Zealand. It gives patients access to an evidence based test that can help determine whether their symptoms could be something sinister.
Limitations of the Public FIT Pathway
While the introduction of this system is a positive step for NZ, there are a few drawbacks we should be aware of.
Firstly, access to FIT testing will be gate-kept by the hospital, this means they will not be as freely accessible as I was used to having in the UK where we kept FIT tests in a stock cupboard and gave them out as we felt appropriate.
Also this pathway is for symptomatic patients only (patients suffering with symptoms) Patients without symptoms who want to be proactive by screening early will still have to purchase a private FIT test.
That means people who are not currently eligible for the National Bowel Screening Programme, for example people below the age of 56 or above the age of 74, will still need to access FIT screening privately if they want to be proactive about bowel cancer detection. This includes many people in their 40s and 50s, and younger people with relevant risk factors or a strong family history.
At True Proactive, our doctor led FIT test is designed for people without symptoms who want access to proactive bowel cancer screening before they are eligible for the national programme, or outside the publicly funded pathway. Or want the ease of access that we specialise in at True Proactive.
Below you can see a list of our FIT testing products, it's never been so easy to be proactive.
Dr Clive Price
Dr Clive Price is a UK trained General Practitioner with over 12 years of clinical experience. He currently practises in New Zealand and founded True Proactive to improve access to proactive, evidence based doctor led health screening services.
