NHS South Tees CCG Rapid Specialist Opinion (RSO)

1. NHS South Tees CCGRapid Specialist Opinion(RSO) Right Care, Right Place

2. Introduction • New process launches on 1 November 2017 • Accessed through GP Clinical system using the e-Referral Booking Service (Choose & Book) • The RSO has a duplicated Directory of Service on e-Referral for each choice of provider, in each speciality and clinic available. • The process requires practices to submit a referral to the RSO via e-Referral System (e-RS). This will generate a dummy appointment which will be converted to a real booking should the patient require a hospital appointment. • The RSO uses existing guidelines to ensure that onward referrals is the most appropriate next step for care and treatment.

3. The process is to be followed for 10 Specialties: Orthopaedics ENT Dermatology Cardiology Gynaecology Ophthalmology General Surgery Neurology Urology Rheumatology • To be used for all Routine and Urgent referrals • Excludes 2ww referrals and very urgent • Very Urgent = life threatening, same day assessment • Urgent = not a suspected cancer diagnosis but symptoms or suspected diagnosis that needs specialist input within 2/3 weeks, that will not wait 18 weeks

4. Implementing RSO in Primary Care

5. Step 1 – Decision to refer • GP or Nurse Practitioner makes decision to refer to secondary care • Message to patient ‘I’m going to seek the advice of a specialist’. Provide patient leaflet • Referrer undertakes choice conversation with patient should they need to see a consultant (choice of provider ie which hospital or clinic the patient chooses) and records choice to be included in the referral letter • The outcome of the referral may be either that the patient needs to be seen in hospital (in this case they will receive an appointment by post) or that they may be contacted by the practice for follow up treatment and management. • NB In the RSO process patient does not receive any appointment information from the GP practice.

6. Step 2 - Submitting the referral to RSO using e-Referral NB: Practices may wish to consider creating the UBRN at the time when the referral letter and other required information is ready. Practices should have a process in place to ensure that every intention to seek specialist opinion is actioned as soon as possible to avoid patient delay in treatment. • Enter e-RS through the clinical record. Select relevant Speciality and Clinic Type. Select ‘Search Primary Care’. Select the RSO duplicate of the patients choice of provider service if not available use any provider and clearly specify choice of provider in the body of the referral letter.

7. Step 3 – Searching for a dummy appointment • To create the ‘dummy’ appointment click Appointment Search

8. Step 4 – Booking the dummy appointment • Select and book available appointment slot. This is a dummy 1 minute appt that enables the RSO to see the referral letter and documentation. • Do not give the patient details of this appointment. • Tip: choose the 4th or 5th dummy appt to prevent the slot from timing out.

9. Step 5: Submitting the referral • Click Submit Referral

10. Step 6: Close appointment summary • To save in clinical system click ‘Close’ • Attach the referral letter and documentation to the UBRN through the clinical system. • Any lab results and diagnostics should be included in the letter.

11. What happens next?

12. The referral has now passed on to the RSO. • The RSO Consultants and GPs with Special Interest carry out clinical triage against CCG agreed clinical guidelines within 2 working days. • 2 outcomes: • Referral sent back to GP via e-RS with clinical advice on how the patient should be managed e.g. request for further diagnostic tests or to be managed in primary care. GP practice to inform patient if outpatient appt is not required and initiate alternative follow up as advised or GP practice to facilitate request for additional information to enable triage. • Onward referral to Secondary Care is managed by the NECS Booking Team(who will issue appointment letter or defer to provider letter if no appointments available). All patients will receive a letter from the NECS team with their Unique Booking Reference Number (UBRN) & Password. The appointment can be rearranged if not suitable.

13. Defer to Provider Letter • The patients choice of provider will contact them to arrange an appointment

14. Booking Letter • If appointment date and time is unsuitable patient can re-arrange via www.nhs.uk/referrals or phone 0345 608888 • Patient Transport can be arranged by contacting Transport Information Service 01642 263122

15. Step 7: Primary Care Worklist Management • The worklist Referrer Action Required should be checked daily for any referrals sent back and actioned accordingly. GP practice to inform patient if outpatient appt is not required and initiate alternative follow up as advised. • If additional information is required it should be attached and returned as soon as possible to enable triage and prevent delay in any patient treatment • Accepted onward referrals are also shown within the worklist.

16. Management of Urgent Referrals • NOT 2ww Referrals or very urgent (outside of RSO) • All urgent referrals to go through RSO • RSO – Consultant will review in 48 hrs • The NECS Booking Team will escalate the urgency if the situation arises • GP to contact the consultant on call/discuss case if admission is likely – not to be referred through RSO

17. Contact: • Any queries/issues regarding the patients referral/booking/appointment contact the NECS team in the first instance using the email address NECSU.Southrso@nhs.net (same day response) • NB practices can track the referral using the ‘Patient History’ within e-Referral, the UBRN will stay on the worklist for 180 days if not actioned. It will drop off the worklist the day after the appointment date • For queries regarding triage advice contact About Health email ah.admin@nhs.net or call 01254 282930

18. Additional Information • A practice handbook including FAQs • Clinical guidelines available on MembersZoneand Ardens • RSO Flowchart • Patient leaflet and FAQs • Any queries regarding local implementation of RSO refer to stccg.rso@nhs.net