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Community Service Usage Pack for Practices

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Community Service Usage Pack for Practices Referral Guidance for Practices March 2020 1 Contents 2ww Breast Pain Clinic MSK MSK Hub Referral Templates Physiotherapy Urology Neurology Headaches Pathway Vague Symptoms Pathway (75 years+) Admission Acute Home Visiting Service Nutrition Community Nutrition and Dietetics Prevention Ambulatory Clinics Call for Care Call for Care - CURT Obesity & Bariatric and Weight Management Tier 3 DVT Clinic Weight Change Point Obesity Prevention and Weight Management Management Service – Tier 1 & 2 Advice and Advice and Guidance Guidance Ophthalmology Ophthalmology referral pathway Cardiology Cardiology via Medefer Other info NUH Treatment Centre Telephone Numbers Continuing Fast Track Pathway Tool Healthcare Rheumatology Early Inflammatory Arthritis (EIA) Pathway Dermatology Community Dermatology Service Rheumatology Advice Line Tele-dermatology Paediatrics Concerning Behaviours (1) Diabetes DESMOND Healthy Families / Small Steps / Community Paeds (2) Paediatric MSK Referral Assessment End of Life End of Life Together Service Pain Community Pain Management Clinic ENT Audiology Management Microsuction Voice Clinic Podiatry Podiatry Referrals Surgical Podiatry Falls Falls Service Safeguarding Domestic Abuse Pathways Gynaecology Continence Clinic Gynaecology Physiotherapy Social Referrals to social prescribing Prescribing Inter-Practice Inter-practice referral referral Tissue Viability Tissue Viability Mental Health Adult Mental Health Referrals CAMHS Eating Disorder Service CAMHS Self-Referral Crisis Resolution Home Treatment Team Dementia Information Service (NEWARK ONLY) 2 GP Advice for Adult Psychiatry Breast Pain Clinic Via e-Referral • This clinic is in addition to the existing 2ww breast cancer referral clinic. The 2ww breast cancer clinic remains unchanged. • The clinic is currently based at PC24. It is anticipated that in the future this service will be run in a Primary Care / Community setting. • Benefits of this service are: • An improved experience for patients with breast pain • Reduced repeat GP attendances • Reduced unwarranted referrals to the breast clinic • Improved early detection of significant breast cancer family history. Clinical Criteria for Referral: • Patients who are unassured after assessment by GP. • Recurrent GP attendances with breast pain as the predominant symptoms. https://midnottspathways.nhs.uk/media/2591/mid-nottinghamshire-breast-pain-clinic.pdf 3 2ww Referral Templates • Please ensure that when sending a 2ww referral that the Ardens referral template has been used. • Please also ensure that this contains all the required clinical information to ensure patients are directed to the most appropriate pathway and speeds up their diagnosis and treatment. 4 2ww Urology Via e-Referral • The 2ww prostate, bladder and general urology clinic has been replaced by a single non-bookable 2ww general urology clinic. • This will streamline the patient pathway and reduce the risks of delays. • All referrals will be reviewed by a consultant and directed to the most appropriate pathway. • Please ensure that the Arden’s referral template has been fully completed. 5 2ww Vague Symptoms Pathway (ages 75+) Via e-Referral • This new pathway provides a structured process for investigating patients with non-specific but serious symptoms which causes the GP to suspect cancer. • This pathway is for over 75 year olds only. SFH are working on a pathway for under 75’s expected to be launched within 6 months. • The referral criteria is: • Cannot place patient on site-specific 2WW pathway • Weight loss in absence of GI symptoms • Unexplained DCT • GP gut feeling that patient has cancer • Anorexia in absence of GI symptoms • Mandatory screening tests (FBC, UE, LFTs, Bone Profile, ESR, TFTs, HbA1c and CXR) must be carrried out before considering a referral on the vague symptoms pathway. Abnormal results should be managed as appropriate including consideration of a site specific 2ww pathway. • Only patients with normal results or abnormal but non-specific results should be considered for the vague symptoms pathway. If the suspicion is a recurrence of a previous cancer the patient should be referred back to the original specialty. https://midnottspathways.nhs.uk/media/2593/vsp-gp-comms-jan-2020-v3-240120.pdf 6 Acute Home Visiting Service Via Telephone – 03000830000 option 8 • Available to take referrals between 8.30am and 5pm Monday to Friday. • Each practice will have a “protected” one visit per day but all other slots will be first come first serviced. If this “protected visit is not taken up by 10am this will be opened up to all. PICS will review the equity of provision through the day to ensure that not all available visits go to one or two practices. https://midnottspathways.nhs.uk/guidance -pathways/out-of-hours-care-urgent-care/acute-home-visiting-service/ 7 Adult Mental Health – Referral Form • For all urgent and routine referrals to Adult Mental Health (AMH) and Mental Health Services for Older People (MHSOP) please use this referral form. • This replaces the e-Referrals and letter referral process. • Referrals to Crisis and Iris services should still be made by telephone as usual. Once the form has been completed please email to the appropriate team (link to emails at the bottom of the form) 8 Advice and Guidance Via e-Referral • Advice and Guidance has been expanded to all specialties. • This is for non urgent requests. • Requests should be responded to within 2-5 working days. As with the current advice and guidance service GPs will be able to: • Receive consultant advice on a treatment plan and/or the on-going management of a patient • Ask for clarification (or advice) regarding a patient’s test results • Seek advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be) • Identify the most clinically appropriate service to refer a patient into Advice and Guidance for Renal Specialist Input and Support in Management and Decision Making • NUH (also covering SFH) are requesting you to submit all written advice and guidance requests via eRS Electronic Referral System. • This ensures that there is a ‘safety net’ in place to ensure that appropriate action is taken for patients. • For any queries please contact [email protected] who can provide any clarifications required. https://midnottspathways.nhs.uk/guidance-pathways/referral-facilitation/advice-guidance/ Audiology (Direct Access) Via e-Referral 10 https://midnottspathways.nhs.uk/guidance-pathways/ent/direct-access-audiology-services/ 10 Bariatric and Weight Management – Tier 3 Via e-Referral • Tier 3 weight management referrals to go to the Tier 3 Bariatric Weight management referral assessment service held at Royal Derby Hospital via e-Referral. • Please see referral criteria on e-Referral. • Bariatric Tier 3 Referral form must be attached with the referral. This can be found in Ardens. • The Post –Operative Bariatric Referral Assessment Service is for patients having Post -Operative problems with Gastric bands, Sleeve Gastrectomy and Gastric Bypass. These patients would not currently be under follow-up at the hospital. 11 https://midnottspathways.nhs.uk/guidance-pathways/obesity-weight-management/bariatric-surgery-tier-3/ Call for Care Via telephone call 01623 781899 Call for Care Details Option 1 • Admission avoidance (2 hour response) – provides a clinician to clinician handover to mobilise a 2 hour response for patients whose health needs have changed, making them at risk of avoidable hospital admission. Once call for care have assessed the patient they will route them into other services required including Hospital at home which is a consultant geriatrician led pathway providing 72 hours of medical monitoring for increased frailty and sub-acute needs. • Community Urgent Response and Rehab Team (CURRT) - Urgent response, Hospital at home, Facilitate early discharge from hospital and Therapy. Intensive rehabilitation for people who have deconditioned functionally as a result of a new health problem. Option 2 • End of Life and Palliative care (For further info see End of Life Together Service) • Patients are navigated through this option by skilled call advisors who will establish whether the patient has specialist or generalist palliative care needs, determine the urgency and ensure the most appropriate clinical response is activated in community services. This pathway includes services provided by: District Nurses, PICS, John Eastwood Hospice Specialists, Nottinghamshire Hospice, Beaumont House, Hospice at Home Services. Please use this option for all new end of life referrals; anyone who is in the last 12 months of life and requests support to manage their needs at home. Option 3 Planned Care (non-urgent referrals for all general health services) • District nursing • Community therapy • Specialist Continence • Specialist nursing (including respiratory services, diabetes and heart failure. District Nursing Aligned to PCNS and provide nursing care for the housebound, such as (but not limited to) Option 3 includes: administration of medicines / injections, wound care, drains, suture / clip removal, pressure area care and continence management (catheters and enemas) Community Therapy Provides an enhanced level of assessment and rehabilitation from OTs and Physio’s to prevent further functional decline and maximise independence. Specialist nurses Support people with long term conditions to optimise their condition through support self-care, this includes Respiratory services,
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