Demand Management
Tools
This pack is intended to support you in meeting your demand
management targets. You should already have received
detailed practice specific targets and information on how this
links to your practice commissioning budget. You should also
have received information on data validation and using Dr.
Foster. These documents on are Lambeth PCT intranet site:
Documents/Demand Management.
This pack provides information, ideas and contacts to help
you achieve each target for:
A&E attendances
Emergency Admissions
1st outpatients
Follow-up outpatients
Feedback/sharing learning
GPpackver1.0final170407
A&E attendances
1.
The target is to reduce unnecessary A&E attendances. This is most likely to
be achieved through:
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
2.
3.
management of frequent /repeat attenders
using the PCT Community Services Case management system for high
risk vulnerable patients (see Emergency admissions section)
improving access to your practice services (including out of hours)
Information which will assist you:

discharge letters from A&E Departments (note: Trusts have been set

details from PCT Community Matrons (case managers) on patients
attending A&E who have had >10 attendances in the previous 12
months (adults and children)
targets to improve speed of discharge letters)
Suggested Practice first steps
1.
Enter all A&E attendance data from discharge letters onto a spreadsheet for
ease of retrieval and monitoring (in the same way that you may enter SELDOC
attendances)
2.
Review of all attendances each month:
a) Patients with > 3 attendances in last 12 months at any A&E: flag notes
to raise at next consultation to determine reasons. Action as necessary – see below
b) Patients with > 6 attendances in last 12 months at any A&E: review
patients notes and invite patient for consultation (standard template: A&E1).
Action as necessary – see below.
c) All attenders – analysis of time of presentation (in/out of hours?/day of
week/time of day), type of patient (?children/adults/non-English speakers) for
trends. Action as necessary – see below.
3.
Ensure that following are in place:
 Seldoc telephone number in practice leaflet
 Seldoc telephone number prominently displayed in practice waiting
area
 Out of hours answerphone message in accordance with best practice
(guidance attached: A&E2)
 Information on nearest pharmacist with minor ailments service (list
attached : A&E3)
2
4.
Possible actions
The greatest benefit is likely to be achieved through management of frequent
attenders.
(a) The highest A&E users are also likely to be high practice attenders and may fall
into the group of patients with multiple/complex problems eligible for case
management.
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


Invite the patient in for a consultatation and/or ensure that they
have a case manager allocated if eligible. See Emergency Admissions
section for contacting case managers.
Identify needs for more proactive management of long term.
conditions. See Emergency Admissions section on long term conditions.
Develop a management plan for very frequent attenders – e.g. to guarantee
a GP appointment at regular intervals, to refuse unnecessary investigations
etc
Give information on out of hours service and explanation of the way the
service works
Give information on NHS Direct – as a a first contact to help decide whether
an urgent/ A&E visit is necessary
Give information on practice and community services available as an
alternative to A&E
(b) The group of patients who attend fairly often for relatively minor illness





From monthly analysis, consider implications of the patterns patients’ of
attendance – e.g. is the practice appointment system difficult to navigate,
should opening hours change, is there sufficient information on practice
nurse/other clinics, are they a high proportion of patient who don’t speak
English as a first language? Are there themes common to frequent A&E
attenders – make appropriate changes.
Invite individual patient in for a consultation to review if they have
unmet needs and/or flag notes to discuss at next consultation.
Give information on out of hours service and explanation of the way the
service works
Give information on NHS Direct – as a a first contact to help decide whether
an urgent/ A&E visit is necessary
Give information on practice and community services available as an
alternative to A&E
(c) Patients with severe and moderate mental health problems may benefit from a
management plan and/or alternative support.

Flag notes for review at next consultation to ensure patient is in
contact with all relevant services including Community Mental
Health Teams, drug and alcohol services.
3
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

Develop a management plan for very frequent attenders – e.g. to guarantee
a GP appointment at regular intervals, to refuse unnecessary investigations
etc
Give information on out of hours service and explanation of the way the
service works
Give information on NHS Direct – as a a first contact to help decide whether
an urgent/ A&E visit is necessary
Give information on practice and community services available as an
alternative to A&E
N.B. Actions to reduce A&E attendances will overlap with actions to
reduce emergency admissions.
Please also note that when assessing practices achievement of the targets, you may
be asked to demonstrate monthly review of A&E attendances.
4
A&E1
Standard letter to invite patient to surgery
Dear
I am writing as I have noticed that you have had to attend at a hospital A&E
Department quite often recently.
I am sorry that you have had so much illness and would like to review the care that
your are receiving.
Please would you make an appointment at the surgery at a time that is convenient
to you to see me or one of my colleagues.
Yours sincerely,
5
A&E2
Out of hours ansaphone messages – good practice suggestions
1.
Messages must be audible, clear and concise.
2.
The telephone number for the out of hours provider (SELDOC 0208 693
9066) must be given twice.
3.
NHS Direct – 0845 46 47 – should be recommended for nurse advice and
information 24 hours a day.
4.
Advice to ring 999 or go to A&E may be included but should not be the first
advice given.
Information on out of hours services is required in practice leaflets.
Suggested information to include ….
The opening hours of this surgery are:
weekdays …………
weekends (if applicable)
You can ring the surgery for advice between the hours ……..
on tel. ………….
If you need urgent care outside these hours, which cannot wait until the next
surgery, there are several things you can do.
You can visit a local pharmacist (chemist) and ask for advice.
You can find health information on the NHS Direct Online website:
www.nhsdirect.nhs.uk.
For information on services or advice from a nurse, you can ring NHS Direct which
is open 24 hours a day. The number is 0845 46 47 and the calls are charged at
local rate.
If you think you need to speak to a doctor urgently, you can ring SELDOC on 0208
693 9066 between 6.30 pm and 8.00 am and all day on saturdays, sundays and
bank holiays.
If you need emergency treatment in a critical or life threatening situation, you
should go to the nearest A&E Department and if necessary ring 999 for an
ambulance.
If you are not sure what to do, ring NHS Direct 0845 46 47 for advice.
6
A&E3
Lambeth Pharmacy Minor Ailments Scheme
North Locality
A & A Chemists (Fresh Chem Ltd) 290 Brixton Rd
ABC Drugstores Ltd - 136/138 Stockwell Rd
B Yuet Leung - 99 Kennington Lane
Cam Pharmacy - 44 Kennington Rd
Halls Chemist Ltd - 240 Wandsworth Rd
Harfleur Chemists - Stockwell Tube Station
Lloyds Pharmacy Ltd - 76 Kennington Rd
Lloyds Pharmacy Ltd - 8 St George Wharf
Medimex UK Ltd - 222 Kennington Park Rd
Medirex Pharmacy - 28-29 Wilcox Close
Millennium Pharmacy - 68 Brixton Rd
Millennium Pharmacy - 102 Loughborough Rd
Paterson Heath & Co Ltd - 143 Lambeth Walk
Pearl Pharmacy - 310 Clapham Rd
R. C. Patel - 457 Wandsworth Rd
Tesco In-Store Pharmacy - 227 Kennington Lane
South East Locality
ABC Drugstores Ltd - 42a Foxley Sq
ABC Drugstores Ltd - 253 Gipsy Rd
Baba Chemist - 7 Tulse Hill
Boots The Chemist Plc - 449 Brixton Rd
Deejay Chemist - 154 Norwood Rd
Herne Hill Pharmacy, 75 Herne Hill
Kingshield Pharmacy - 387 Brixton Rd
Pascoe Pharmacy - 235 Knights Hill
Pavilion Pharmacy - 9 Brighton Terrace
Sefgrove Ltd - 3-5 Westow Hill, Upper Norwood
Superdrug Pharmacy 452/456 Brixton Rd
Upper Tulse Hill Chemist - 23 Upper Tulse Hill
W Redparth & Sons - 377 Norwood Rd
South West Locality
ABC Drugstores Ltd - 5 The High Parade
Boots The Chemist Plc - 206-208 Streatham High Rd
Boss Pharmacy - 213 Clapham Park Rd
Copes Pharmacy - 570 Streatham High Rd
Hillrise Pharmacy - 222 Brixton Hill
Jackson Chemist - 88 Streatham Hill
Kamsons Pharmacy - 86 Clapham Manor Street
Mokwell Pharmacy - 110 Brixton Hill
New Park Pharmacy - 85 New Park Rd
Orbis Pharmacy - 148 Clapham High Street
Pearl Pharmacy - 31 Clapham High Street
Phillips Pharmacy - 46 Poynders Road
Prentis Pharmacy Ltd - 240 Streatham High Rd
Shacklock Chemist - 239 Streatham High Rd
Superdrug Pharmacy Ltd - 202-204 Streatham High Rd
Westbury Chemists - 84-92 Streatham High Rd
Participating Pharmacies
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7
Emergency Admissions
1.
There are two main areas for action on emergency admissions:


2.
case management of vulnerable patients at high risk of admission
(these may be patients with long term conditions including sickle cell)
management of patients with Long Term Conditions
Using the PCTs Case management system
The Case management team includes 6 Community Matrons and additional case
managers who identify patients with a high risk of admission through the use of a
Predictive tool (PARR2) and data on frequent attendances at A&E.
The main tasks of the case manager are to:
 Enable and empower self-management and develop a patient centred
care plan
 Advocate for the patient
 Prevent avoidable unplanned hospital admissions
 Coordinate and evaluate the effectiveness of all agencies and services in
meeting the needs of the patient
 Act as a first and main point of contact for patients and their family and
carers
 When appropriate, discharge patient as self managing, or to GP or
community services eg District Nurse
For Community Matrons, contact your Locality Office or:
North Locality: Beatrice Kaunda
07789922312
WeiLin Roberts
07767244119
South West:
Gina Roberts
07771 793 9937
Graham Williams
07771 794 011
South East:
Deirdre Cornish-Browne
07789 868 649
Rachel Turner-Peard
07789 868 326
3.
Management of Long Term Conditions
For patients with lower risk and therefore not eligible for case management, review
regularly to ensure that they are receiving proactive care which will prevent their
risk of admission increasing.
There are a range of specialist teams and GPswSIs available across Lambeth e.g.
Community Heart Failure team. For more information, contact your Locality Office
and see the Alternative Care Pathways below OP1.
For advice/discussion re medicines management and prescribing, contact
lelly.oboh@lambethpct.nhs.uk 0207 716 7163
8
1st Outpatient attendances
1.
The target is to reduce unnecessary new outpatient attendances in the
acute sector. Tthis target will be measured on all new attendances (that is referrals
from all sources minus DNAs) as this is the basis for payment to the acute
providers.
These targets reflect an average reduction required across all specialties. The
following specialties account for approximately 50% of our local activity and costs:
ENT, gynaecology, ophthalmology, trauma and orthopaedics, rheumatology,
cardiology.
2.
This main actions to help you reach your practice target are:

use Referral checklists to guide decision making on referral (Checklists
circulated April 2007. See also Lambeth PCT intranet: Documents/demand
management/checklists)
3.

consider use of alternative care pathways available (summary: OP1 and
Lambeth PCT intranet: Documents/demand management)

ensure that you adhere to the Exceptional Treatment Arrangements (clinical
effectiveness) policy (previously circulated but also at Lambeth PCT intranet:
Documents/Exceptional Treatment Arrangements)
We also encourage you to:

Undertake peer review of referrals (within the practice, locality or
consortia) – maximising the capacity and skills across the PCT

Be proactive in challenging non-adherence to the Consultant to
Consultant referrals policy. The GSTT policy is attached (OP2) and has
also been adopted by Kings. St. Georges’ are have not yet confirmed
their approach.

Attend checklist launch/teaching sessions/multi-disciplinary meetings on
management of specific conditions being organised by the PCT
4.
The PCT is keen to evaluate the effectiveness of checklists and you may be
asked to participate in audits.
5.
Please also note that when assessing practices achievement of the targets,
you may be asked to demonstrate use of referral checklists.
9
Follow up outpatient appointments
1.
The target is to reduce unnecessary acute follow up appointments. This may
mean follow up in primary care or in some instances discharging the patient
from follow up.
2.
The main actions recommended are:

review patients having frequent or regular follow up out patient
appointments

where clinically appropriate, actively seek discharge of patients
from acute care by use of the standard letter attached (OP3)
10
OP 1
Alternative Care pathways
A number of practices have requested support and advice on alternative care pathways, in particular what options are available to referrers and
how specific referrals are paid for i.e. what is in a block contract and what is on a cost and volume contract.
Providing clarity on this issue may help practices to make informed decisions, which will contribute to demand management target delivery and
reduce avoidable expenditure against PBC budgets
You will note the table below references the Little Yellow Book distributed to all practices and available on www.lambethpct.nhs.uk
For acute tariff options, please refer to the Choose and Book Choice menu.
Problem
Audiology
Back
Heart Failure
Dermatology
GPpackver1.0final170407
Non-tariff options available in 2007/08
Service Description: Paediatric community audiology clinics
Location(s): Matpother House, Paxton Green Health Centre and Wlifrid Sheldon Centre
Contacts: Audiology at KCH Tel: 0207 346 5343
Service description: Back pain assessment services
Location: Kings and GSTT (St Thomas’)
Contacts Kings: Lorna Rose Tel: 020 3299 8212
GSTT: Kathy Payne Tel: 0207 188 5092 Bleep: 2281
Service Description: BNP test for suspected heart failure (this is recommended as a first line
diagnostic, prior to echo).
Location: Please send blood test to GSTT or KCH and mark BNP on the blood referral form.
For samples being sent to GSTT use a yellow top U&Es bottle, for samples being sent to
KCH use a plastic bottle containing EDTA anticoagulant (FBC specimen bottle). Samples
being sent to KCH must be received by the laboratory within 8 hours of collection.
Contact: Nina Herrington at Lambeth PCT, Tel: 020 77174737
OR
North Locality:
Amanda Parsons
South West Locality: Lilly Mandarano
South East Locality: Anna Hodgkinson
Service Description: Help and advice in management of dermatological conditions from a GP
with a Special Interest (please do not send patient referrals). Only operating until the end of
March 2007.
Location: Practice Based
Contacts: South East: Tyrrell Evans, tyrrell.evans@gp-G85039.nhs.uk , Tel: 020 8670 6878
South East: Denise Robertson, Denise.Robertson@gp-G85016.nhs.uk , Tel: 020 7274 3314
South West: Adrian McLachlan, Adrian.McLachlan@gp-G85045.nhs.uk , Tel: 020 7274 4220
North: Neil Vass, Neil.Vass@gp-G85123.nhs.uk , Tel: 020 7622 1424
COPD
Diabetes
Service Description: COPD Service development in progress. More details to follow.
Service Description: Three Diabetes Specialist Nurses and two GPSIs cover the
localities (both practices and community staff). They do NOT accept routine patient
referrals but will advise, train, educate, signpost to sources of support and undertake
joint patient visits/consultations/clinics.
Location: Will attend any practice or community team
Contacts: North: Julia.Azille@gstt.nhs.uk , Tel: 020 7188 1906
South West: Rosarie.Atkinson@gstt.nhs.uk , Tel: 020 7188 1962
South East: Deirdre.McGowan@gstt.nhs.uk , Tel: 020 7188 9799
North: Dominic.Costa@gp-G85086.nhs.uk , or Dominic.Costa@gstt.nhs.uk , Tel: 020 7622
1923
South: Mark.Chamley@gp-G85022.nhs.uk , Tel: 020 8761 6259
Diabetes retinopathy screening
Service Description: A satellite of the Diabetes Eye Complications Service (DECS) is
due to open in Streatham in the new year.
More details to follow.
Elderly care
Service description:
 GSTT Elderly care- fax letter to 020 7188 7630
 Telephone advice (Monday-Wednesday: 07796612063 Thursday-Friday:
07786526202)
 Community consultant clinics (off tariff) @ Pulross or Whittingdon. Transport provided.
Held Tue pm (W) Wed am (P) & Wed pm(W) within 1/52 access.
 For admission to either LCCC or Pulross Centre contact the TACT team 020-82332545/2544 or Fax 020-8243-2530 Monday to Friday 9am to 6pm (planned or same
day admission can be arranged)
 Rapid Response Team to prevent unnecessary admission contact (will assess patient
within 2 hours) 07917-554516. 7 days a week 8am to 8pm (please call as early as
12


Emergency admissions
Falls
Knees
possible)
Day hospitals – Guys/ Dulwich – rapid access full OPD assessment & investigations
(may prevent full admission tariff) – Guys Tel/ Fax Dulwich Tel/ Fax
Elderly care Consultant opinion by telephone. To request an opinion on a
potential emergency admission to GSTT Call 0207 188 4488 Monday to Friday 09.00
to 19.00
NB Consultants will divert to OPD or IC bed if appropriate (off tariff) rather than hospital (in
tariff).
Service description: Case management may reduce emergency admissions for high intensity
users/patients at risk of frequent readmissions
Location: N/A – one of your local case managers
Contact: Joiss Soumahoro Tel: 0207 717 7074 or your community matron
NB. Elderly care Consultant opinion by telephone. To request an opinion on a potential
emergency admission to GSTT Call 0207 188 4488 Monday to Friday 09.00 to 19.00
Service description: Falls specialist multidisciplinary assessment/ management includes
consultant, nurse and therapies- transport provided (off tariff)
Letter/ referral to LCC/Pulross/Whitt 1/52 pick up.
Location: Clinics weekly at LCC & Whittingdon
Contacts: Telephone advice from Day unit staff at Pulross: 02007411 6610 (Jenny /Jean) or
Whittingdon 020 8243 2500 (Jane/ Oslyn)
Service description: Knee Assessment Service – operating to the end of June 2007 only
Location
Guys’ and St Thomas’, Pulross, LCC. Kathy Payne GSTT 0207 188 5092
South-West: Gill Baker Tel: 020 8243 2038 Email: gill.baker@lambethpct.nhs.uk
GHD (due to start in April 07): Stephen Miller Tel: 020 8670 6878 Email:
Stephen.miller@paxtongreen.nhs.uk
Minor surgery
Service description: Sigmoidoscopy, excision of cysts, lipomas etc, injection of
haemorrhoids, skin lesions (carried out by Dr Wickremesinghe under local
anaesthetic)
Location: The Grantham Centre Practice, Beckett House, Grantham Road, SW9 9DL
13
Contact: Julie Higgins Tel: 020 7733 6191, Fax: 020 7737 2870 Email: jhiggins@gpg85100.nhs.uk
Phlebotomy (Murray)
Community Nursing Team provides phlebotomy for housebound patients.
Service description: community phlebotomy services
Location Herne Hill Group covering Herne Hill Group, Tulse Hill, Deerbrook, Brockwell Park
and Herne Hill Road
Contact: Lyn Eustace Telp: 020 7274 3314, lyn.Eustace@gp-G85016.nhs.uk
Physiotherapy
Podiatry
Podiatric Surgery
Service description: Community musculoskeletal service (Block contract)
Location: Pulross and Lambeth Community Care Centre cover whole borough.
Urgent patients all seen within 3 days
Contact details: Fax referral form to Pulross 020 7411 6613, LCC 020 7411 5869
or Whittingdon 020 8243 2542.
Phone with urgent referral/ for advice – Pulross 020 7411 6610. LCC 020
7411 5840
Service Description: No direct referral can be made to the hospital based podiatry service at
St Thomas' and Guys from general practice. It comes via a hospital based consultant. The
community foot health team can provide all footcare required with the exception of bespoke
footwear.
Location: Round house and Whittingdon Centre, 11-13 Rutford Road , Streatham, SW16
2DQ
Contact: 0208 243 2546
Service description: alternative to orthopaedic foot and ankle surgery based in the hospital operate under local anaesthesia on a daycase basis. Referral criteria and pathways being
drawn up (due to be completed in Feb)
Location: Pulross Centre
Contact: Tel 020 7411 6647 Email: podadmin@lambethpct.nhs.uk Fax: 020 7411 6613
Popodaediatric
Service Description: Developmental issues for children and their gait.
Location: Lambeth Community Care Centre
Contact: Hiresh Patel, 020 74115840
Reproductive and sexual health clinics
Service description: Sexual & reproductive health clinics offer a full contraception service as
14
well as some screening for sexually transmitted infections.
Location: Kings RSH, 100 Denmark Hill, Camberwell, SE5 9RS
Lambeth RSH – clinics run in: Moffat Clinic / Mawbey Brough / Clapham Manor / Streatham
Hill
Contact for opening times:
Kings Tel: 020 7346 5000
Lambeth RSH Tel: 020 7411 5728
For information on all local sexual health services http://www.mysexualhealth.org.uk
Sickle cell
Service description: Screening, genetic counselling, health advice and education, case
management for adults and children with complex needs relating to sickle cell, drop-in clinics,
training for health and non-health professionals
Location: South East London Sickle Cell and Thalassaemia Centre, Wooden Spoon House, 5
Dugard Way, Kennington, SE11 4TH
Contact: Evelyn Otako Tel: 020 7414 1363 Fax: 020 7414 1357
Email evelyn.otako@lambethpct.nhs.uk
Stroke or TIA
NB 999 if stroke suspected
For TIA or review of ‘old’ stroke with deteriorating neurology (i.e. prevent stroke & full
admission tariff)
Telephone advice (off tariff) – Nurse specialist Monday to Friday: 9am-5pm, Tel: 020 7188
7188 bleep 1765
Review / reassessment /advice (off tariff) -Weekly Multidisciplinary specialist stroke clinic
Pulross. All Lambeth residents (including KCH discharges) Transport provided.
Fx letter/ referral form to w7411 6613 Advice Tel day unit staff Jenny /Jean- 7411 6610
Service description: A specialist nurse advisory service, offering telephone advice and home
visits for patients with difficult to manage wounds
Location: Block B, Dulwich Hospital, East Dulwich Grove, East Dulwich, London, SE22 8PT
Contact: Caroline Hunter, 020 7346, 6443, caroline.hunter@southwarkpct.nhs.uk
Tissue viability TBC
Thank you for considering alternative options. If you are aware of other services, please contact Harprit Lally on harprit.lally@lambethpct.nhs.uk
and we will continue to update and expand the options.
15
OP 2
Internal Out Patient Referral Policy
1.0 Introduction
John Bacon wrote to all PCTs and acute trusts in April 2006 setting out plans for
bringing London NHS back into balance over 2006/7, with the expectation that PCTs
would deliver a balanced plan and that acute trusts would co-operate with the Pan
London Demand Management proposals. These proposals include the requirement to
shift the responsibility for tertiary referrals from the acute trusts back to the PCT.
GSTFT and Lambeth PCT have agreed a set of underlying principles which:






minimises delays in clinically urgent cases;
minimises patient inconvenience;
minimises clinical risk;
shifts the responsibility and accountability for tertiary referrals from acute trusts back
to the PCT;
gives control of referrals to the GPs and is entirely consistent with the principles of
Practice Based Commissioning;
is consistent with the requirements of the 18 week pathway;
2.0 Internal Tertiary Referrals
Whilst it is recognised that consultant to consultant referrals make up the majority of
internal tertiary referrals this policy also applies to referrals between other healthcare
professionals.
In order to allow the PCT to manage referrals, clinicians should not be referring directly
to colleagues but should be writing to the GP and advising on appropriate treatment or
referral.
The Trust will be required to monitor internal tertiary referrals and will not be funded for
referrals outside the exceptional categories. If there is any doubt whether a referral is
legitimate it should be discussed with the SDU Head in the first instance and with the
Divisional Director if still unclear.
Internal tertiary referrals will be allowed in exceptional cases, as follows:
GPpackver1.0final170407
1. The referral relates directly to the original reason for referral. The patient has
associated symptoms requiring input from several clinical teams & examples
might include:



Examples of this might be multi system disease or where input from another
clinician is an essential part of the diagnostic or treatment pathway.
A patient referred with SLE but presenting with a raised creatanine direct referral
to nephrology would be legitimate.
patient referred with diabetes and found to have diabetic retinopathy - referral to
ophthalmology would be legitimate.
2. Cases where, possibly because the presenting problem was unclear, the
original referral was to the wrong clinical team and the patient is redirected to the
appropriate specialty
3. Referrals from A&E where failure make an OPD referral may result in either
admission or re attendance at A&E.
4. The referral is urgent, for example:
 Suspected cancer.
 Where a short delay might be life threatening or is likely to impact on the long term
prognosis.
Other internal tertiary referrals will no longer be funded by the PCT and patients
must be referred back to the PCT with advice on treatment and/or referral to the
appropriate speciality where:



The referral is for a secondary condition
The referral is loosely associated with the original problem, rather than a direct
symptom of the presenting condition. An example of this might be a transplant
patient who requires a hip replacement – this should be referred back to the GP
with the advice to make a referral to orthopaedics.
The referral does not fall into any of the exceptional categories above.
Maggie Hicklin
Divisional Director, Acute Patient Services
31st June 2006
17
Internal Out-Patient Referral Protocol
Tertiary Internal OPD Referral
Is this referral necessary to diagnose or treat the
condition that the patient was originally referred
for?
NO
YES
Make referral.
Inform GP
Is the referral
urgent e.g. cancer
YE
S
Make referral.
Inform GP
Refer back to GP.
New 18 week pathway
starts
NO
Refer back to GP.
New 18 week
pathway starts
18
EXAMPLE: DISCHARGE FROM OUTPATIENT FOLLOW-UP
OP4
Dear
Patient Name/DOB etc. NHS number
Thank you for your management of this patient with ______ . I have
reviewed our records and your recent correspondence and I am
confident that this patient can be well managed in a primary care setting
from now onwards.
I would be grateful if you could use the patient’s next attendance to
review your records and confirm that this course of action is appropriate.
If you agree that discharge to primary care is appropriate, please advise
me of any management plan that I should action in the future.
Obviously, if I take over the (insert specialty) care of this patient, I am
willing to accept clinical responsibility.
If, following that consultation, you feel there are other factors that need
to be taken to consideration, I would be grateful for your advice.
I am happy to discuss the patient by phone if you would prefer this.
Your help is most appreciated.
With best wishes,
Yours sincerely
19
Feedback and sharing learning
Comments on this pack
I would like more information on …….
The information on …………. is not clear
Demand management suggestions (for sharing with other practices):
An intervention I have carried out successfully is ……..
This intervention has reduced demand for …..
An intervention which I have tried but didn’t work is ….
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