Advice & Refer A practical guide for Secondary Care Homerton Healthcare NHS Foundation Trust

Context

Feedback from Primary Care

Common issues identified from A&G and A&R conversations are:

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.

Rejected referrals without a clear explanation

A high-quality referral should allow secondary care to make a decision without further clarification.

Request for GP to submit a referral, instead of converting A&G to referral Unclear or vague advice, with no next steps Requests for diagnostics to be performed without checking existing results

This guide will help secondary care consultants: ✓ Improved constructive advice and refer communication with GPs ✓ Reduce unnecessary back-and-forth between GP and consultant ✓ Reduce delays to patients accessing the most appropriate care.

Improved constructive advice and refer communication with GPs

Reduce unnecessary back-and-forth between GP and consultant

Reduce delays to patients accessing the most appropriate care.

Unclear or vague advice, with no next steps

Requests for diagnostics to be performed without checking existing results

How to make your response to GPs clear and actionable

Be clear on next steps required by GP Convert advice and guidance to a referral if appropriate Check available test results attached, on PACS or HIE before you request test results from the GP Use professional and supportive language (patients may be able to view the A&R conversation in their medical record or referral)

Convert advice and guidance to a referral if appropriate

Check available test results attached, on PACS or HIE before you request test results from the GP

Use professional and supportive language (patients may be able to view the A&R conversation in their medical record or referral)

Accepting Referrals

• Provide clear booking instructions. Use the name of the clinic on EPR.
• Good Examples
• Please book into any ENT Telephone Clinic
• Book into next available Foot/Ankle Clinic at SLG
• Avoid generic instructions
• Book into Tuesday clinic

Advice Conversations

• GPs can only see communication in the eRS text box, not embedded in documents.
• Once a referral has been accepted, GPs can no longer receive alerts of any additional communication on eRS.

Rejecting Referrals

Be clear when rejecting referrals on the reason for rejection and clear next steps.

For Example:

• 'This service is not available at Homerton. Please refer to another Trust.'

Redirecting Referrals

• 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.
• Avoid sending back to the GP unnecessarily.

Ask for Further Clarification

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.

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.

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.