Manchester Integrated Care Gateway: Appeals Process – GTD Triage

The following guidance describes the process in relation to any clarification or challenges the referring GPs would like regarding the decisions made by the triage clinician.

Stage 1 - Informal

Referring GP wants to discuss the triage recommendation made by the Triager to either:

  • Clarify the advice and guidance provided.
  • Suggest alternative referral route.
  • Discuss criteria for Non Commissioned Procedure (NCP) decision.
  • And /or agree next steps.

Contact needs to be made within two working days after receiving the outcome.

Should the referrer wish to discuss the triage recommendation with the Triage clinician then they should contact the Choose and Book team on 0161 443 0631 who will provide the relevant contact information.

Stage 2

If the referrer following discussion with the Triage clinician remains dissatisfied with the outcome, an Appeals Form should be completed and together with the referral will be sent to a second Triage clinician for a second opinion (within a further working day).

NOTE: Should the referrer request a second opinion, then the Appeals Process Form needs to include the reason for the appeal and any additional information which will assist the second Triage clinician in making their assessment. The request should clearly indicate the triage case reference number and should be sent to GTD via

Stage 3

In the event that the referrer remains dissatisfied following the second opinion, the case will be escalated to the MICG Clinical Lead / CCG Clinical Lead*.

NOTE: Should the referrer request a final review by the Triage Clinical Lead / Clinical Commissioning Group Clinical Lead, then the Appeals Process Form needs to be updated to include any additional information which will assist the Clinical Lead in making their assessment. The request should clearly indicate the triage case reference number and detail the reason for the appeal and should be sent to GTD via

  • In the event, following stage 1, 2 or 3 above, that the referring clinician and the triage clinician agree that the referral is appropriate for onward referral then the referral should be sent back via the MICG with a clear documentation of ‘discussed with Dr ..... on..... date and time ...... advised resend referral ....’ in the notes section of the referral letter and attach a copy of the letter from GTD confirming referral outcome approved.

*In the case of the MICG/CCG Clinical Lead and the Triager being one and the same then another MICG/CCG Clinical Lead will be involved.

  • Should the originating referrer still not be satisfied with the outcome following triage clinical lead consideration then the option for referral to the Independent Funding Review (IFR) panel will be offered. Please state that you been through the Appeals process for the Gateway.
  • After consideration, the IFR panel will either uphold or reject the appeal.
  • Upheld appeals will be confirmed in writing by the IFR panel to the originating referrer. The referring GP will then re-send the referral with the accompanying IFR approval to the MICG for direct processing without the need for further triage. Please also state in the Referral Reason box that this has received IFR approval.
  • Rejected appeals will also be notified to the referrer.

12.04.2012 MICG Appeals Process – GTD Triage