Referral Update for Practices

29th July 2019

The information below is for all Practices to ensure that your patients are being supported through the pathways and e-referral service effectively.

2WW referrals messages to patients

When referring patients for a 2WW dermatology referral please ensure that you:

• Tell the patient that this is an appointment and ensure that they have the necessary paperwork
• Check that you are booking your patient into the correct clinic i.e. Dermatology clinic-TWW-Stepping Hill-Salford Royal Foundation Trust.

Patients are getting booked into the incorrect clinic at Salford Royal which can cause delays in them being seen as they have to be cancelled from one clinic and rebooked into the right one.

It can cause patients a lot of distress at what is already an anxious time. If there are no clinic slots available then please defer to provider and they will then contact your patient to book an appointment.

For all other 2WW referrals please advise your patients that they will be contacted by the provider directly. Your patient should not be given the paperwork but be advised that the hospital will contact them within 48 hours. It is essential to ensure that you provide up to date contact details for your patients.

For all 2WW referrals please ensure that your patient is fully aware of the reason that they are being referred to secondary care and the importance of attending their appointment.

We continue to have patients delaying their initial outpatient appointments and appearing to be unaware of the reason for their referral.

Spinal pathway unexpected cancer findings

 There have been several occasions recently where patients attending the Spinal Assessment Service at BMI The Alexandra have had an unexpected cancer finding on undertaking diagnostics.

There has then been confusion as to who is then responsible for the onward referral to secondary care.

The following process has therefore been agreed by Dr Simon Woodworth, CCG Clinical Director:

• If the findings are primary bone cancer your patient should be referred by BMI straight to secondary care as a 2 week wait via the e Referral Service.
• If the findings are metastatic/secondary tumour/s, BMI should urgently refer your patient back to you requesting that you refer on to the most appropriate tumour group

Foot and ankle pathway changes

With effect from 1 September 2019 all referrals for foot and ankle problems with the exception of red flags must be referred via the MSK Podiatry foot and ankle referral assessment service on the e Referral Service.

This can be found under:

All referrals will be clinically vetted and patients referred to the most appropriate clinician. Patients need to be told that the provider will contact them directly.

• Any foot and ankle referrals sent direct to secondary care which do not meet the red flag criteria will be rejected back to the practices resulting in a delay for your patients.

ECGs reminder

Practices are reminded that as part of the GP Development Scheme they should be carrying out ECGs as ‘clinically required.’

However it is recognised that on occasion practices may run into problems due to staff sickness etc. In the first instance practices should seek support from other practices and/or Viaduct.

If unable to gain ECG capacity via this route then the practice should email contact the CCG contracts team at STOCCG.contractqualityandperformance@nhs.net requesting that on a temporary basis ECGs are carried out by Stockport NHS Foundation trust. The following information needs to be included:

• Explaining what the issue is
• What actions they have undertaken to mitigate this,
• How long this situation is expected to continue.

The contracts team will then discuss the request with the Head of Primary Care Development-Julie Ryley. Following this the outcome will then be communicated to the practice at the earliest opportunity.

Any queries regarding this pathway please contact Dr Simon Woodworth, CCG Clinical Director at simon.woodworth@nhs.net

Rapid Access Chest Pain Clinic 

Practices are reminded that referrals for the above clinic must be made via the e Referral Service. Paper referrals will no longer be accepted.

The clinic can be found on the e Referral Service at:

Dexascan bookings 

Practices are reminded that referrals for the above must be made via the e Referral Service. Paper referrals will no longer be accepted.

The Dexascan form is available as an EMIS template. Dexascan requests must include the GPs GMC number to be accepted as valid by the x-ray department.

The clinic can be found on the e Referral Service at:

Advice and Guidance (A+G) request

Advice and Guidance is in the process of being rolled across all specialties. This enables you as a clinician to have a two way ‘conversation’ with your colleagues at the acute trust.

It is intended that you should ask a specific question/query and include relevant test results.

Specialties currently available below.

• Adult Continence Service – Community
• All trauma and orthopaedic specialties including paediatric
• ENT Adult
• ENT Adult Loss of Hearing
• ENT Paediatric
• Cardiology
• Chest (eRS speciality-respiratory medicine)
• Clinical Haematology
• Endocrine & Diabetes (eRS speciality-endocrine and metabolic medicine)
• Falls Clinic (eRS speciality-geriatrics)
• Frailty Service (eRS speciality-geriatrics)
• Gastroenterology
• Gynaecology
• General paediatrics
• Paediatric ADHD
• Paediatric Allergy
• Paediatric Cardiology
• Paediatric Endocrine
• Paediatric Epilepsy
• Paediatric gastroenterology
• Paediatric Immunisation
• Paediatric Surgery
• General surgery (eRS speciality surgery-not otherwise specified)
• Lipid (eRS speciality-endocrine and metabolic medicine)
• Medicine for Older People  (eRS speciality-geriatrics)
• Pain
• Parkinsons (eRS speciality-geriatrics)
• Rheumatology
• Upper GI (eRS speciality-GI and liver medicine and surgery)
• Uro-gynaecology (eRS speciality –gynaecology)

Please ensure that when you are using the A+G option on the e Referral Service that you type your question/query into the intended box and include relevant tests results/reports/ECGs etc.

Please do not attach a referral letter. Instructions for using A+G can be accessed using the link: www.stockportccg.nhs.uk/practicehub/ccg-documents/referrals/

Heart failure clinic reminder

Prior to referral to this clinic please refer to the pathway in the link below:

www.stockportccg.nhs.uk/practicehub/ccg-documents/pathways/

Can you also ensure that that your patients BNP result is clearly stated at the beginning of the referral letter. This helps the person who is triaging the referrals to ensure that patients are seen in the most appropriate clinic within a given timeline. 

Worklists

Practices are reminded that you should be checking your worklists on a daily basis. The most important worklist you check should be ‘referrer action required.’

Any patients who have had the referral ‘rejected’ by a provider will appear on this list. It is the practices responsibility to contact these patients to let them know what has happened and what the next steps are.

Practices should also have processes in place for patients who fail to attend appointments especially children and any patients who are vulnerable. Also those patients who fail to book appointments when sent a request letter.

These patients will appear on the ‘appointments not yet booked’ worklist.

Further information

If anyone has any questions or need additional training around the e Referral Service please contact Cath Comley, Commissioning manager at cath.comley@nhs.net or on 07826 904613