5 March 2024
1. Document Purpose
This policy has been developed to facilitate timely and appropriate referrals into secondary care to ensure our patients receive the right care, in the right place, first time.
2. Background
The rapid transfer of unwell patients to an appropriate care provider in a timely way is one of the highest patient safety priorities for our ICS. We need to ensure that our systems, processes and lines of communication are fit for purpose and account for the ever changing landscape of healthcare provision.
To ensure delivery of this core requirement we also require services, policies and procedures that promote that the notion that inpatient care is not the default option where viable, appropriate and safe care could be provided in an alternative setting, ideally closer to or in the patient’s own home.
To achieve these two goals, collaboration is needed to ensure efficient, seamless transition between care providers. This requires trust, respect and understanding between professionals and organisations so that the patient remains at the centre of all we do.
The advent of the Urgent Care Coordination Hub, developments in Primary Care workforce and ongoing pressure on our Urgent and Emergency Care services have prompted this paper which aims to outline a number of principles of engagement at the Community/Secondary Care interface.
3. Policy Scope
Specifically, this policy:
- is applicable to patients in the Nottingham and Nottinghamshire Integrated Care System
- applies to same day/urgent referrals to secondary care services at Nottingham University Hospitals (NUH) and Sherwood Forest Hospitals (SFH). (Outpatient and Planned Care referral pathways are excluded)
- applies to all specialties within secondary care within the Nottinghamshire ICS at NUH and SFH
- replaces any current ‘exclusion’ criteria (whether formal or informal) that gate-keep access into specialist services. This is to ensure a consistent approach for our patients and clarity of process for our NHS team members.
4. Secondary Care Urgent Referral Policy
a) Inter-organisation and inter-professional communication should maintain a patient-centred, problem solving approach to avoid unwarranted or unnecessary delays or barriers. Standards of expected values and behaviours must be maintained at all times.
b) Any credible, appropriately trained and experienced clinician working in any Nottingham and Nottingham NHS service can refer to secondary care acute specialties directly. This specifically includes, but is not limited to, providers of Primary Care, Community Care, Mental Health, Virtual Wards, 111, Navigation and Ambulance services.
c) In addition to General Practitioners, it is expected that such referrals will come directly from Advanced Nurse Practitioners, Physicians Associates, Urgent Care Practitioners and Paramedics where it is appropriate to do so.
d) Care Providers will need to ensure that authorised referrers have ‘clinical credibility’ and are trained to convey the relevant information to the receiving secondary care service which outlines the reason for, and urgency of, the referral.
e) The referral process will include a verbal conversation to enable the transfer of information and support dialogue between referrer and receiving service.
f) It should be noted that all practitioners listed will need to be either under direct supervision of General Practitioners or are practicing under regulation of organisational statutory clinical governance structures.
g) For some complex cases, it will be necessary and advisable for a senior clinician (e.g. GP) to provide direct advice and review potential referrals to ensure consistency and appropriateness.
h) The clinician receiving the referral needs to have the appropriate skillset to effectively manage the referral with knowledge of and access to all appropriate and safe Admission Avoidance options (e.g. SDEC, Virtual Ward, Hot Clinics etc).
i) Where clinically acceptable, safe and appropriate to do so, admission and attendance avoidance options should be considered and promoted by all parties.
5. Policy monitoring process
To ensure consistent implementation of this policy across the ICS, the existing processes for incident reporting and feedback should be followed. This will also facilitate learning and education across the system improving the appropriateness of referrals and reducing unwarranted clinical variation.
Monitoring and feedback will be achieved through the following:
- The current GP process for feedback to specialties is found at Appendix 2 – via F12. This will be expanded to include additional roles working within GP practices.
- The outcome of referrals to specialties via the ambulance service will be recorded on the EPRF (Electronic Patient Record Function) and a summary will be collated through the existing failed/successful pathway reporting process
- Clinicians from Specialty teams should feel able to provide balanced feedback to referrers and their supervisors regarding appropriateness and content of referrals. A written feedback mechanism is in development to ensure a more systematic process to record and share learning.
- A similar process will also be developed for other community services.
- Policy Review Date: 1st October 2024
- Policy developed by ICS Clinical Navigation Group
