CONSULTANT TO CONSULTANT INTERNAL REFERRALS POLICY INTERNAL REFERRALS SHOULD

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CONSULTANT TO CONSULTANT INTERNAL REFERRALS POLICY INTERNAL REFERRALS SHOULD CONSULTANT TO CONSULTANT INTERNAL REFERRALS POLICY INTERNAL REFERRALS SHOULD CONSULTANT TO CONSULTANT INTERNAL REFERRALS POLICY INTERNAL REFERRALS SHOULD CONSULTANT TO CONSULTANT INTERNAL REFERRALS POLICY INTERNAL REFERRALS SHOULD






Consultant to Consultant Internal Referrals Policy


Internal referrals should be made between consultants in the following circumstances:


1. Clinically urgent problem referred by the GP requires further investigation by a hospital

clinician


For investigation, assessment or treatment of a clinically urgent problem e.g. suspected cancer when no diagnosis established by the first Consultant.

Example: A patient is referred to colo rectal Surgery with symptoms of bowel cancer and no

bowel cancer is found; the patient needs referral on to another speciality to exclude other

abdominal conditions.


2. Original problem referred by the GP requires further investigation by a hospital clinician


Further investigation, assessment or treatment of the presenting signs and symptoms is required and

this cannot be carried out by the GP or first Consultant.

Example: A patient with shortness of breath who has been seen by the Respiratory Physician

may need to be internally referred to the Cardiologist for some symptoms.

Patients with minor symptoms should be sent back to their GP e.g. a patient with dizziness should not be referred from ENT to Neurology unless clinically urgent.


3. Pre-operative Assessment


Patients who have a significant medical problem that is identified at pre-operative assessment; the

condition prevents surgery and requires specialist advice/treatment.

Example: A patient with previously undiagnosed angina.

However, if the patient has a problem that is routinely dealt with in primary care, e.g. diabetes,

hypertension, dermatology, they should be returned to the GP.


4. A&E


Patient diagnosed with a serious underlying condition and the symptoms do not require

Admission

or

Direct referral pathways agreed from Emergency Department and the following specialist

clinics:

Renal colic, Urinary retention, TIAs, DVTs, Fracture clinic, Knee clinic, ENT and

Maxillo Facial clinic, Rapid Access Chest pain clinic, Arrhythmias (to cardiology clinic) and

Seizures - especially first fit.


5. Symptoms which are part of a recognised care pathway


The presenting sign or symptom indicates that the patient will be managed within an agreed pathway which requires specialist input at the next stage.

Examples: A patient with carpal tunnel syndrome who has a confirmed diagnosis with nerve

conduction studies; a rheumatology patient who needs orthopaedic surgery.


6. Referrals within a Speciality for the Same Condition

The GP has referred to the correct speciality but the wrong Consultant with no charge to be made for the referral for the right consultant..

If the GP has referred the patient to the wrong speciality and does not fall within the above categories, the referral should be sent back to the GP for action


7. Where patients do not fall into the above categories


They should be sent back to General Practice. Example: a patient with retinal eye disease who has been seen by the ophthalmologist should NOT be internally referred to another Consultant for treatment of diabetes or hypertension (this will usually be identified prior to referral)


8. Return of patients to GPs

When a patient is referred to another Consultant or back to their GP, it is important to ensure that the patient and the GP are informed who will be responsible for future management. Any delay in

administrative processes should be minimised wherever possible and the GP informed by email or

letter within 5 days.


9. Key Principles

It is expected that all internal referrals will be formally authorised by the Consultant in charge rather

than a junior doctor.


10. Notes


11. 2016/17 NHS Standard Contract Service Condition 8

This new service condition and for the sake of clarity, we outline below how this is interpreted by the commissioner.


8.3 If the Provider considers that a Service User has an immediate need for care which is outside the scope of the Services, it must notify the Service User, Carer or Legal Guardian (as appropriate) and the Service User’s GP of that need without delay and must co-operate with the Referrer to secure the provision to the Service User of the required treatment or care, acting at all times in the best interests of the Service User.


This is accepted by commissioners as an urgent requirement


8.4 If the Provider considers that a Service User has a non-immediate need for treatment or care which is within the scope of the Services and which is directly related to the condition or complaint which was the subject of the Service User’s original Referral or presentation, it must notify the Service User, Carer or Legal Guardian (as appropriate) of that need without delay and must (unless referral back to the Service User’s GP is required as a condition of an Activity Planning Assumption or Prior Approval Scheme) provide the required treatment or care in accordance with this Contract, acting at all times in the best interest of the Service User. The Provider must notify the Service User’s GP as soon as reasonably practicable of the treatment or care provided.


This must relate to the same body part or presenting complaint eg stomach pain: a referral between a medical and surgical speciality is acceptable. Dizziness: a referral between ENT and Neurology is accepted.


8.5 Except as permitted under an applicable Prior Approval Scheme, the Provider must not carry out, nor refer to another provider to carry out, any non-immediate or routine treatment or care that is not directly related to the condition or complaint which was the subject of the Service User’s original Referral or presentation without the agreement of the Service User’s GP.


As an example, a patient referred for osteoarthritis of a knee should not be then seen for pain in another joint.







Policy Name:

Consultant to Consultant Referral Policy

Policy Date:

19 April 2016

Ratified by:

Clinical Commissioning Committee

Clinical Owner:

Abid Irfan

Review Date:

April 2018



5 WHEATON COLLEGE WRITING CENTER CONSULTANT APPLICATION ABOUT THE
7 OED GUIDANCE POLICY ON HIRING OF CONSULTANTS OED
ADMINISTRACIÓN TRIBUTARIA CANARIA PERSONA O ENTIDAD CONSULTANTE DOMICILIO CONCEPTO


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