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Electronic Referrals Pilot

Questions asked by Practices

Service/Area / Question / Answer
1 / System & Process / What if there’s an IT problem? / Initial response 02/05:If there is an IT problem causing e-referrals to go down, there is already a process in place whereby hardcopy referrals should be sent. This is as follows:
  • 2ww & urgent referrals – should the system be unavailable for >24 hours
  • Routine referrals – should the system be unavailable for >48 hours
On both occasions, the CCG will email practices first, advising when they should send hardcopy.
2 / System & Process / What if the GP wants to make a referral after home visits? / Initial response 02/05:For referrals done after home visits –GPs would either send a referral via e-Referrals once they were back at practice, or task this to a member of the practice admin team. We are also looking into whether GPs have access to e-RS through mobile working.
3 / Advice & Guidance / We write letters asking for advice that sometimes become a referral / Initial response 02/05:For advice prior to referral – there are a couple of processes currently in place:
  • Advice & Guidance via the e-Referrals system – should a referral then be required, this would be done in the usual way via e-Referrals.
  • Consultant Connect – for some specialties
Please also see Appendices 1 & 2
4 / Service
TB / How do we send referrals for Tuberculosis?
On the Mid-Notts Clinical Pathways Website this states to post or fax. On e-Referral under Infectious Diseases there isn’t a clinic for SFHFT. However under Respiratory Medicine there is a clinic.
  • We understand that referrals need to be send under Respiratory Medicine – is this correct?
  • Are there any nurse-led clinics?

5 / Service
Lymphedema / Lymphedema clinic - Roundwood Surgery queried how to book into this service, as they send paper referrals as there isn’t a clinic on e-Referral.
Are we right in thinking that this is a therapist-led service? / Initial response09/05: advised Roundwood to continue sending paper referrals until we receive confirmation that this is a therapist-led service.
6 / Advice & Guidance / Roundwood Surgery sends paper Advice & Guidance to named consultants. They don’t do this on e-Referral as they can’t choose a specific consultant to send it to. If the consultant then wants to see the patient this is classed as the referral. / Initial response 09/05:CCG advised practice that if a patient wants to see a specific consultant but the consultant cannot be found on e-Referral to let us know so we can ask SFHFT to add the consultant – meanwhile, the practice is to add the requested consultant to the referral letter.
However the practice has advised that the consultants don’t look at this and patients don’t end up in their clinic. Previously if the practice can’t find a named consultant they contact LH from the Trust who lets the practice know the clinics the consultant is working so she can book the patient into the correct appointment. Roundwood has said that they will let the CCG know any named consultants not listed on e-Referral.
Please also see Appendices 1 & 2
Service/Area / Question / Answer
7 / Service
Osteoporosis / Osteoporosis clinic – This is directly bookable on e-Referral however MCH requests that these are posted hardcopy. / This is being looked into. The service live on e-referral is for the diagnostic (dexa scan) so GPs can use this to book the diagnostic. The service SFHFT are in the process of putting onto e-referral is the consultant OP appointments service

Appendix 1: Advice & Guidance via e-Referrals

  • Advice Guidance has been a core element of the NHS e-Referral Service (and previously Choose Book) since it was launched and has a number of benefits for practices, providers and patients. It allows referrers to communicate directly with a provider clinician or specialist regarding the treatment of their patient, without the need to send a referral. This may include asking another clinician for their advice on a treatment plan or on-going management of a patient, clarification regarding test results or seeking advice on the appropriateness of a potential referral.
  • Using e-Referrals/Advice & Guidance, referrers can simply ask a question or send an attached letter, scan results or scanned images and, once the referrer has received a response, they can easily convert the Advice Guidance into a referral via e-referrals, if appropriate. All of the supporting clinical information supporting the Advice Guidance and any subsequent referral are sent safely and securely to the chosen provider.
  • Providers offering Advice Guidance must ensure that agreed response times are in place to give referrers the confidence that they will receive a response in a timely manner.
  • As part of the plans to improve the NHS e-Referral Service, Advice & Guidance has been further enhanced in April 2017 to enable a ‘multi-way’ conversation (similar to email) between referrer and specialist.

At point of selecting referral, you also have an option to select advice (see diagram below). This will send your query through to the relevant speciality and they will respond.

Appendix 2: Consultant Connect

Consultant Connect is a new telephone solution that allows GPs to contact local hospital specialty consultants directly and immediately, often with the patient in front of them. The GP dials a local number and the call is answered by a local specialty consultant, typically in under a minute.

  • Typical wait time is under a minute.
  • Typical call duration is 3 to 5 minutes.
  • At the end of the call, the consultant rates the call as “referral made” or “referral avoided”. A recording of the call is stored in a secure vault for patient and medico-legal purposes.
  • Bridges the communication gap between primary and secondary care.

A recently completed review of Consultant Connect’s performance over 7 months in a Southern CCG area showed:

  • Number of specialties on the system:5
  • Number of calls made over the 7 month period:> 1,000
  • Typical wait time for GP to be connected with local specialty consultant:48s
  • %of answered calls resulting in patient avoiding an unnecessary trip to hospital:72%
  • %of users who feel that Consultant Connect is good for healthcare:> 95%
  • %of users who feel that Consultant Connect helps GPs and consultants work better together:> 95%

During the review, GPs and consultants were asked to describe a typical call to Consultant Connect. Here are a few of their responses:

GPs

  • I was concerned about a patient’s deteriorating renal function and wondered whether they needed emergency admission. The consultant advised an alternative course of action which was successful and avoided an admission.
  • Confirmed patient management plan.
  • Has helped in the interpretation of blood results and their significance, has prevented at least one referral.
  • Elderly care. Outpatient MRI organised by consultant, who followed up with patient afterwards. Great service.
  • I didn’t think patient needed referral but they were unhappy with this. By speaking to a consultant with the patient present and the consultant agreeing they didn’t need to be seen, the patient accepted GP management.
  • Cardiology – confirmed the need for a NON-urgent referral.

Consultants

  • Anticoagulation decisions, drug doses and advice.
  • Advice on test results to avoid referral, decide on treatment or guide next step in investigations. All also have an educational element for the GPs.
  • Interpretation of results. Advice re further investigation.
  • Advice on urgency of referral handling of abnormal imaging results and blood tests.
  • What to do with TFT, how to treat thyroiditis, what to do with low cortisol.

Appendix 3: Schemes under Development: Ardens

The CCG are in the process of implementing Arden’s decision support tool into every practice. This software sits within System One. The software is both a clinical system and an admin function; saving time for both clinical staff and efficient use of admin staff. There are some useful videos telling you more;

What it gives you?

  • Capture consultations based on national guidance
  • Ease workload by auto-filling forms e.g. Cremation, DN drug charts
  • Consistent templates and supporting guidance to reduce wasted time
  • Standardised self-care information (patient.co.uk/ ARC leaflets but ability to link to bespoke local information, e.g. list of IAPT providers).
  • Standardised referral forms, referral criteria
  • Templates can be used by GP and admin teams
  • Shared decision making with ability to develop SystmOne templates that could be used by a range of clinicians in a range of environments
  • LTC/EOL - consistent use of templates by community services, standard formulary, ability to generate drug charts, cremation forms etc
  • Paperless working with the option to email patients leaflets
  • Ardens will not slow down your practice desktop

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