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            "text": "Advice & Refer\nA practical guide for Secondary Care Homerton Healthcare\nNHS Foundation Trust",
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            "text": "Feedback from Primary Care",
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            "text": "Context",
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        {
            "id": "p1.7",
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            "text": "Common issues identified from A&G and A&R conversations are:"
        },
        {
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            "text": "The purpose of this guide is to improve the quality and process of advice and refer by improving communication between GPs and secondary care teams."
        },
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        {
            "id": "p1.10",
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            "bbox": {
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            "text": "Rejected referrals without a clear explanation"
        },
        {
            "id": "p1.11",
            "order": 11,
            "type": "text",
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            "text": "A high-quality referral should allow secondary care to make a decision without further clarification."
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            "type": "figure",
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            "id": "p1.13",
            "order": 13,
            "type": "text",
            "bbox": {
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            "text": "Request for GP to submit a referral, instead of converting A&G to referral\nUnclear or vague advice, with no next steps\nRequests for diagnostics to be performed without checking existing results"
        },
        {
            "id": "p1.14",
            "order": 14,
            "type": "text",
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            "text": "This guide will help secondary care consultants:\n✓ Improved constructive advice and refer\ncommunication with GPs\n✓ Reduce unnecessary back-and-forth between GP and consultant\n✓ Reduce delays to patients accessing the most appropriate care.\nImproved constructive advice and refer communication with GPs"
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        },
        {
            "id": "p1.19",
            "order": 19,
            "type": "figure",
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        },
        {
            "id": "p1.20",
            "order": 20,
            "type": "heading",
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            "text": "How to make your response to GPs clear and actionable",
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        {
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        },
        {
            "id": "p1.25",
            "order": 25,
            "type": "text",
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            "text": "Convert advice and guidance to a referral if appropriate"
        },
        {
            "id": "p1.26",
            "order": 26,
            "type": "text",
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            "text": "Be clear on next steps required by GP Convert advice and guidance to a referral if appropriate\nCheck available test results attached, on PACS or HIE before you request test results from the GP\nUse professional and supportive language (patients may be able to view the A&R conversation in their medical record or referral)"
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            "id": "p1.27",
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            "id": "p1.28",
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            "text": "Accepting Referrals",
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        {
            "id": "p1.29",
            "order": 29,
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            "bbox": {
                "l": 34.5496,
                "t": 314.8239,
                "r": 194.8211,
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            "text": "",
            "attrs": {
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            "children": [
                {
                    "id": "p1.29.1",
                    "order": 30,
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                    "text": "Provide clear booking instructions.\n  Use the name of the clinic on EPR.",
                    "marker": "-"
                },
                {
                    "id": "p1.29.2",
                    "order": 31,
                    "type": "list_item",
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                    "text": "Good Examples",
                    "marker": "•"
                },
                {
                    "id": "p1.29.3",
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                    "text": "Please book into any ENT Telephone Clinic",
                    "marker": "-"
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            ]
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            "id": "p1.30",
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            "text": "- Book into next available\nFoot/Ankle Clinic at SLG"
        },
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            "type": "list",
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            "text": "",
            "attrs": {
                "item_count": 2
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            "children": [
                {
                    "id": "p1.31.1",
                    "order": 35,
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                    "text": "Avoid generic instructions",
                    "marker": "•"
                },
                {
                    "id": "p1.31.2",
                    "order": 36,
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                    "text": "Book into Tuesday clinic",
                    "marker": "•"
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        {
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        },
        {
            "id": "p1.33",
            "order": 38,
            "type": "heading",
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            "text": "Advice Conversations",
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            "level": 3
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        {
            "id": "p1.34",
            "order": 39,
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            "text": "- GPs can only see communication in the eRS text box, not embedded in documents."
        },
        {
            "id": "p1.35",
            "order": 40,
            "type": "text",
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            "text": "- Once a referral has been accepted,\nGPs can no longer receive alerts of any additional communication on eRS."
        },
        {
            "id": "p1.36",
            "order": 41,
            "type": "figure",
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        {
            "id": "p1.37",
            "order": 42,
            "type": "heading",
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            "text": "Rejecting Referrals",
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            "id": "p1.38",
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            "text": "Be clear when rejecting referrals on the reason for rejection and clear next steps."
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            "text": "For Example:",
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        {
            "id": "p1.40",
            "order": 45,
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            "text": "• 'This service is not available at Homerton. Please refer to another Trust.'"
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        {
            "id": "p1.41",
            "order": 46,
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        },
        {
            "id": "p1.42",
            "order": 47,
            "type": "heading",
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            "text": "Redirecting Referrals",
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            "level": 3
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        {
            "id": "p1.43",
            "order": 48,
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            "text": "If the referral is in the wrong clinic, please accept the referral and request our admin team to book into the appropriate clinic or service."
        },
        {
            "id": "p1.44",
            "order": 49,
            "type": "text",
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            "text": "- Avoid sending back to the GP unnecessarily."
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            "order": 50,
            "type": "figure",
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            "order": 51,
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            "text": "Ask for Further Clarification",
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            "level": 3
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        {
            "id": "p1.47",
            "order": 52,
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            "id": "p1.49",
            "order": 54,
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            "text": "The patient has a booked appointment in the same speciality at a different Trust. Query this with the referrer and ask the reason for this. It may be patient choice."
        },
        {
            "id": "p1.50",
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            "text": "The patient is under the care of their local community teams and/or another Trust outside C&H for their condition. Query if this is the most appropriate clinic, as the patient may prefer continuity of care from their local Trust. The choice may be intentional and due to patient choice or second opinion."
        },
        {
            "id": "p1.51",
            "order": 56,
            "type": "footer",
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            "text": "Thank you to all the teams involved in the Task and Finish Group to develop this guide - The Heron Practice, Lower Clapton Group Practice, Spring Hill Practice, Homerton Trust Consultants and Admin team.",
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