Referral Policy

Referral Policy – Cedars Medical Centre

Introduction

1.1 – Policy Statement

At The Cedars Medical Centre, staff will make certain that the referral process is followed diligently to ensure contractual obligations are met and all patients receive timely referrals to consultant-led outpatient appointments using the NHS e-Referral Service (e-RS). All staff involved in the referral process are to adhere to the guidance detailed within this policy and the referenced documents.

Referral Processes

2.1 – Overview

It is a contractual requirement that all referrals are made using the NHS e-RS. It is the responsibility of the clinician to ensure the referral is made promptly following the decision within the consultation. Furthermore, upon receipt of any referral request, the secretarial team will endeavour to process this request and forward via e-RS within the locally agreed timescales.

When you and your doctor agree that you need an appointment with a specialist, a system known as ‘Choose and Book’ will be used which shows your doctor which hospitals or clinics are available for your treatment. Your doctor, if they have the time, during clinic, will discuss with you the clinically appropriate options which are available for treating your medical condition. (Please note: in order to provide the fastest possible transmission method, referral information may be sent electronically via the NHS Spine (a private, secure and confidential NHS internet).

2.2 – Clinical Responsibility

Clinical staff are reminded that should they delegate any element of patient care, they remain responsible for the overall management of the patient. NHS Digital reiterates this by stating that the clinician remains responsible for the clinical consequences whenever they delegate responsibility for referring, accepting, redirecting or rejecting NHS e-referrals to a non-clinician.

2.3 – Urgent Referrals

In cases when the clinician wants to make an urgent or two-week wait referral for suspected cancer patients, this is to be done using e-RS in line with the 28-day Faster Diagnostic Standard. Should there be no directly bookable appointments available, the referrer is to use the defer to provider function. This transfers the responsibility for booking the appointment to the chosen speciality/provider.

From the referrals options summary screen, the referrer and patient will see a date by which the patient should have heard from their chosen provider. Referrers can monitor the status of such referrals using the awaiting booking worklist feature.

This organisation has in place a protocol to monitor all referrals to ensure they are processed effectively and patients receive an appointment within the expected timeframes.

2.4 – Inter-Practice Referrals

Within the local Primary Care Networks (PCN) there may be occasions when it is necessary to make an inter-practice referral. An example of this would be when one of the ARRS roles, such as a physiotherapist, is based in one of the PCN member practices and it is not possible, for reasons of space or availability of equipment, for that role to move from PCN member practice to PCN member practice.

If referral information is required, this can be sent by secure NHS email to the specialist role. It will be for the PCN member practices to agree how this is to be done and a local protocol agreed.

Waiting Times

3.1 – Waiting Times Exceptions

As outlined in the Handbook, there are circumstances when the right to treatment is subject to exceptions, including the following:

  • The patient chooses to wait longer
  • Delaying the start of their treatment is in the patient’s best clinical interests, e.g., when stopping smoking or losing weight is likely to improve the outcome of the treatment
  • It is clinically appropriate for the patient’s condition to be actively monitored in secondary care without clinical intervention or diagnostic procedures at that stage
  • The patient fails to attend appointments that they had chosen from a set of reasonable options
  • When treatment is no longer necessary

3.2 – The 28-Day Faster Diagnosis Standard

The 28-day Faster Diagnosis Standard ensures patients are diagnosed or have cancer ruled out within 28 days of being referred by this organisation through the

e-RS. The Faster Diagnosis Standard will apply to patients:

  • Referred by their GP on a suspected cancer pathway
  • Referred by their GP with breast symptoms when cancer is not initially suspected
  • Referred by the National Screening Service with an abnormal screening result

 

Patients with non-specific symptoms will be referred using the non-specific symptom pathways. NHS England’s Faster diagnosis contains detailed guidance.

Referral Follow-Up and Feedback

4.1 – Pushing Back on inappropriate Workload

The British Medical Association (BMA) has produced a range of letter templates that this organisation can use to help push back on inappropriate workloads from ICBs, prescribers, hospitals and other providers.

This organisation may decide to maintain a record of the numbers and categories of inappropriate workloads and provide this information to the LMC to strengthen local negotiations. While this requires administrative work from this organisation, it will involve less work than acting on inappropriate hospital requests.

4.2 – Secondary Care Contractual Requirements

The Standard NHS Contract Service Conditions outline the actions of secondary care providers in relation to the following:

  • Local access policies
  • Discharge summaries
  • Outpatient clinic letters
  • Onward referral of patients
  • Medication on discharge
  • Medication following an outpatient appointment
  • Results and investigations
  • Fit note
  • Patient queries
  • Shared care

Should this organisation be concerned that a local secondary care provider is not fulfilling its contractual obligations and is creating an inappropriate workload, the Practice Manager is to write to the relevant department using the templates provided at section 4.1. Should inappropriate workloads continue, the Practice Manager is to liaise with the local ICB to determine the most appropriate way of dealing with such issues.

Further information relating to the NHS Standard Contract can be sought by emailing  nhscb.contractshelp@nhs.net.

4.3 – Private Referrals

Private referrals (letter i.e. university, fit to travel etc.) are not subject to the NHS rules and hence provision of this service will incur a fee which can be discussed with the clinician or an administration staff.  The list of fees is available and will be provided upon request.  The turn-around time for such a referral request can be discussed with the clinician.  The approximate turn-around time for a referral is 2 weeks.  However, we aim to get all referral requests done within a week in most instances.

4.4 – Guide to NHS waiting times in England

As mentioned above the turn-around time for most referrals are 2 weeks.  Please do not call the practice to ask if referrals are done before 2 weeks from the date of request.  Once referral is sent and dependent on the severity of your condition, your referral request will be subject to the ‘NHS waiting times in England guidelines’.  Please refer to the ‘Guide to NHS waiting times in England’ for further information.  If the severity of your condition has changed since your referral, then please let the surgery know so that we can notify the hospital accordingly.  However, this does not mean that the practice is able to change the wait times as the waiting times are monitored, reviewed and any decision on changes to waiting times and priority is at the discretion of the hospital and their staff.  If you have any questions regarding the length of your waiting times then you can contact the hospital you were referred to directly and ask to speak to the relevant department.

 Audit

5.1 – Requirements

The aim of a referral choice audit is to ensure that this organisation is meeting the standards of best practice in terms of the referral process. In addition, when necessary, the audit will identify areas for improvement, enhancing service delivery and patient experience.

Audits are the responsibility of all staff. It is therefore imperative that all are aware of the requirements of specific audits and the frequency at which they should be conducted.