Referral Policy

Introduction

1.1 – Policy Statement

At Godiva Group of Practice’s, staff will make certain that the referral process is followed diligently to ensure contractual obligations are met and all patients receive timely referrals to consultant-led outpatient appointments using the NHS e-Referral Service (e-RS). All staff involved in the referral process are to adhere to the guidance detailed within this policy and the referenced documents.

Referral Processes

2.1 – Overview

It is a contractual requirement that all referrals are made using the NHS e-RS. It is the responsibility of the clinician to ensure the referral is made promptly following the decision within the consultation. Furthermore, upon receipt of any referral request, the secretarial team will endeavour to process this request and forward via e-RS within the locally agreed timescales.

When you and your doctor agree that you need an appointment with a specialist, a system known as ‘Choose and Book’ will be used which shows your doctor which hospitals or clinics are available for your treatment. Your doctor, If have a time during clinic, will discuss with you the clinically appropriate options which are available for treating your medical condition. (Please note: in order to provide the fastest possible transmission method, referral information may be sent electronically via the NHS Spine (a private, secure and confidential NHS internet). However, if you do not wish this electronic method to be used you can advise the practice accordingly and your referral will be sent in the post.

2.2 – Clinical Responsibility

Clinical staff are reminded that should they delegate any element of patient care, they remain responsible for the overall management of the patient. NHS Digital reiterates this by stating that the clinician remains responsible for the clinical consequences whenever they delegate responsibility for referring, accepting, redirecting or rejecting NHS e-referrals to a non-clinician.

2.3 – Urgent Referrals

In cases when the clinician wants to make an urgent or two-week wait referral for suspected cancer patients, this is to be done using e-RS in line with the 28-day Faster Diagnostic Standard. Should there be no directly bookable appointments available, the referrer is to use the defer to provider function. This transfers the responsibility for booking the appointment to the chosen speciality/provider.

From the referrals options summary screen, the referrer and patient will see a date by which the patient should have heard from their chosen provider. Referrers can monitor the status of such referrals using the awaiting booking worklist feature.

This organisation has in place a protocol to monitor all referrals to ensure they are processed effectively and patients receive an appointment within the expected timeframes.

2.4 – Inter-Practice Referrals

Within the local Primary Care Networks (PCN) there may be occasions when it is necessary to make an inter-practice referral. An example of this would be when one of the ARRS roles, such as a physiotherapist, is based in one of the PCN member practices and it is not possible, for reasons of space or availability of equipment, for that role to move from PCN member practice to PCN member practice.

If referral information is required, this can be sent by secure NHS email or via using Joy APP to the specialist role. It will be for the PCN member practices to agree how this is to be done and a local protocol agreed.

Waiting Times

3.1 – Waiting Times Exceptions

As outlined in the Handbook, there are circumstances when the right to treatment is subject to exceptions, including the following:

  • The patient chooses to wait longer
  • Delaying the start of their treatment is in the patient’s best clinical interests, e.g., when stopping smoking or losing weight is likely to improve the outcome of the treatment
  • It is clinically appropriate for the patient’s condition to be actively monitored in secondary care without clinical intervention or diagnostic procedures at that stage
  • The patient fails to attend appointments that they had chosen from a set of reasonable options
  • When treatment is no longer necessary

3.2 – The 28-Day Faster Diagnosis Standard

The 28-day Faster Diagnosis Standard ensures patients are diagnosed or have cancer ruled out within 28 days of being referred by this organisation through the

e-RS. The Faster Diagnosis Standard will apply to patients:

  • Referred by their GP on a suspected cancer pathway
  • Referred by their GP with breast symptoms when cancer is not initially suspected
  • Referred by the National Screening Service with an abnormal screening result

Patients with non-specific symptoms will be referred using the non-specific symptom pathways. NHS England’s Faster diagnosis contains detailed guidance.

Referral Follow-Up and Feedback

4.1 – Pushing Back on inappropriate Workload

The British Medical Association (BMA) has produced a range of letter templates that this organisation can use to help push back on inappropriate workloads from ICBs, prescribers, hospitals and other providers.

This organisation may decide to maintain a record of the numbers and categories of inappropriate workloads and provide this information to the LMC to strengthen local negotiations. While this requires administrative work from this organisation, it will involve less work than acting on inappropriate hospital requests.

4.2 – Secondary Care Contractual Requirements

The Standard NHS Contract Service Conditions outline the actions of secondary care providers in relation to the following:

  • Local access policies
  • Discharge summaries
  • Outpatient clinic letters
  • Onward referral of patients
  • Medication on discharge
  • Medication following an outpatient appointment
  • Results and investigations
  • Fit note
  • Patient queries
  • Shared care

Should this organisation be concerned that a local secondary care provider is not fulfilling its contractual obligations and is creating an inappropriate workload, the Practice Manager is to write to the relevant department using the templates provided at section 4.1. Should inappropriate workloads continue, the Practice Manager is to liaise with the local ICB to determine the most appropriate way of dealing with such issues.

Further information relating to the NHS Standard Contract can be sought by emailing  nhscb.contractshelp@nhs.net.

Audit

5.1 – Requirements

The aim of a referral choice audit is to ensure that this organisation is meeting the standards of best practice in terms of the referral process. In addition, when necessary, the audit will identify areas for improvement, enhancing service delivery and patient experience.

Audits are the responsibility of all staff. It is therefore imperative that all are aware of the requirements of specific audits and the frequency at which they should be conducted. For further detailed information, refer to the Referral Choice Audit Policy.

Medication Management Review

Introduction

1.1 – Policy Statement

The purpose of this document is to provide guidance to enable the practice to complete a medicines management review, evidencing change and improvements in at least three areas of prescribing.

1.2 – Status

This document and any procedures contained within it are contractual and therefore form part of your contract of employment. Employees will be consulted regarding any modifications or change to the document’s status.

What is a Medication Review?

It is a confidential consultation carried out by your GP, or a pharmacist or advanced nurse practitioner from your GP surgery, who has full access to your full medical notes. The objective is to reach an agreement with you about your medicines, optimise the impact of the medicines you’re taking, reduce the number of problems you might be having with them, and reduce waste.

2.1 – What do we do in a Medication Review?

  • To check if the appropriate medication has been prescribed for your needs.
  • To check if the medication has been effective.
  • To check if the medication was a cost-effective choice.
  • To check if all the required monitoring like blood pressure, blood tests etc, are all up-to-date.
  • To check if there had been any significant drug interactions, especially if you are taking any medication over the counter or complementary treatment.
  • To check if you are experiencing any unacceptable side effects.
  • To check your compliance with the medication.
  • To check if lifestyle and non-medicinal interventions have been utilised / considered.
  • To check whether there had been any unmet needs.

2.2 – Who needs a Medication Review?

A medication review is recommended for anyone who gets a repeat NHS prescription for any long term health condition, particularly those with multiple conditions and those with complex medicine regimes.

Your GP may also request that you have a regular medication review at regular intervals, usually done annually. You can also make an appointment at any time to discuss any concerns you have, or you can discuss them with your pharmacist.

2.3 – How often should a Medication Review take place?

Medication review will take place once a year unless GP feels it is warranted more frequently for clinical reasons.

2.4 – How can I Book a Medication Review?

You  can book medication review by booking appointment with GP or Practice Clinical Pharmacist. Your GP / Clinical pharmacist will let you know whether it can be carried out over the telephone or it needs face to face appointment.

2.5 – Preparing for you Medication Review

Your review may be over the telephone, however it can also be booked in person.

  1. Mark the date and time of the appointment and who you are going to talk to in your diary or calendar.
  2. Make a list of all medication that you take. This includes:
    • Any medicines that are prescribed for you (by GP, or hospital or elsewhere).
    • Any medicines that you buy over the counter from the chemist or other stores e.g. painkillers, vitamins etc.
    • Any medicines that you no longer take.
  1. You may want to make a list of questions about your medicines. Examples include:
    • Why is it important to take this medicine(s)?
    • When and how to take the medicine(s)?
    • How do I know the medicine is working?
    • What should I do if I have problems with the medicine?
    • Are there any medicines or food that I should avoid taking whilst on these medicine(s)?
    • What will happen if I miss a dose of the medicine or stop taking it?
  1. If you have been asked to get blood test done prior to medication review ,please collect blood test form from surgery and get the blood test done at least a week before medication review is due so that results are available during medication review.

2.6 – What will happen if your medication review is not Done?

We will send you an invitation to book your appointment for the medication review, when it is due. We will send you a reminder every month for the next 3 months to arrange a medication review. If you do not respond to these requests, for safety reasons, the practice will have to restrict the quantity of medication on further prescriptions for another month. If you still do not book your medication review, the practice will not issue further supplies until you have had the medication review with the clinician at the practice, as it would be deemed clinically unsafe.

We encourage all patients to take responsibility for their own health, therefore, we ask that you be aware when your review is due and respond as soon as possible.

If a script is rejected please contact the surgery to book either a face to face or telephone appointment with GP or Clinical Pharmacist in the practice as soon as possible. Unfortunately due to the high volumes of script requests processed every day the reception staff are not able to contact patients personally to inform them of script rejections.

Medications are ONLY withheld or stopped when PATIENT SAFETY is at risk.

Please be assured that your health is important to us and we would not block, stop or withhold any prescriptions without a valid reason. Please feel free to contact us to discuss any concerns you may have regarding your medication.

Thank you for helping us provide the best support to you.

Cervical Screening Programme Guidance

Introduction

1.1 – Policy Statement

The aim of our cervical screening programme is to reduce the incidence of cervical cancer by promoting its screening.  In collaboration with Public Health England (PHE) we provide a reliable system for calling and recalling all women who are eligible for cervical screening based on the NHS Cervical Screening Programme Good Practice Guide No.2  (July 2011).

The % of patients aged from 25 to 64 whose notes record that cervical smears have been performed in the last five years. We should be hitting at least 80% of patients.

Policy and Processes

2.1 – Effective Administration

CQC GP mythbuster 104: Cervical screening advises that effective administration is a key part of the cervical screening pathway, and that every organisation must have a reliable cervical screening system that includes:

  • Standard operating procedures and detailed work instructions that follow guidance on the national screening programme
  • Routine review of the prior notification list (PNL) to identify who should be invited, and non-responder lists to follow up people who have not attended
  • Processes to ensure that:
    • All tests are transported safely to the laboratory
    • A result is received for each test
    • The appropriate action is taken based on the result of the test
    • Samples are not repeated within three months to avoid being rejected
    • A programme of audit and non-conformance monitoring is in place, including regular review of performance data for individual sample takers

2.2 – Call and Recall Process

The practice cervical screening programme is managed by PHE, who communicate direct with patients.  PHE will send the practice a Prior Notification List (PNL) which we will then check and verify that the women listed are indeed eligible for the Cervical Screening Programme. This will then be returned to PHE. The GP or PN must authorise the PNL if a woman is removed from the list for any other reason than moved away.

Each smear taker is responsible for ensuring that the results are back for all the smears they have done and that relevant follow up has been initiated.

The call and recall service must send all PNL lists to GP practices 70 days prior to the individuals’ NTDDs. The programme recommends these are sent electronically to the practices. When the PNLs are returned, the call and recall service should process any requests for an update within five working days.

2.3 – Eligibility and Screening Intervals

NICE advises that cervical screening is available for people with a cervix as follows:

Age Type and frequency of screening
24.5 years of age The first invitation is issued to ensure that the screening test can be completed by their 25th birthday
25 – 49 years Recall every three years (with invitations issued 34.5 months after the previous test)
50 – 64 years Recall every five years (with invitations issued 58.5 months after the previous test)
65+ years Invited if a recent cervical cytology sample is abnormal and/or they have not had a cervical screening test since 50 years of age and they request one

2.4 – Withdrawing from Screening

Individuals have the option to voluntarily withdraw from the cervical screening programme and detailed information is available in the ceasing guidance. This guidance also includes information on the deferral process.

Patient information is available for those wishing to opt out of NHS screening programmes.

Colposcopists can also cease individuals in the following scenarios:

  • Prior radiotherapy to the cervix
  • Absence of the cervix

A template letter that can be sent to patients wishing to withdraw from the programme can be found at Annex A and a disclaimer template can be found at Annex B.

2.5 – Transgender (Trans) or Non-Binary people

A trans man or non-binary person registered as female who has a cervix will be automatically included in the screening programme. However, a trans man or non-binary person registered as male who has a cervix will not be invited for screening by the national screening programme. Therefore, screening invitations will need to be made manually by this organisation.

A trans man or non-binary person who wishes to withdraw from cervical screening does not have to mention their trans or non-binary status if they do not wish to (it is not necessary for anyone to provide a reason for withdrawing).

2.6 – Objecting to Data processing

Cervical screening: guidance for call and recall administration best practice states that people have a right to request that their data is no longer processed in the screening programme. However not all data can be removed as per Section 17 of the UK General Data Protection Regulations. Processing personal information is necessary to deliver a safe and effective screening service and is required even if a person has opted out of screening. Historical data held by NHS organisations may need to be retained (for example in case there is an incident and an affected individual needs to be told).

Requests to cease data processing must be sent to PCSE Patient Registrations Department to implement. Once received, the relevant details are notified to the call and recall service to enable the screening history to be deleted.

2.7 – Consent

At this organisation, the decision to attend for cervical screening rests with the person who is invited, and it is important that any decision a person with a cervix makes is informed. Consent must be recorded in the individual’s healthcare record.

Additional guidance can be found in the Cancer screening: informed consent document.

2.8 – Supporting Patients with Learning Disabilities

Screening uptake is lower in people with learning disabilities compared to the general population and this organisation has a legal duty to make reasonable adjustments for people with learning disabilities. There are a range of resources available for staff to enhance access, including guidance for health professionals on helping patients with learning disabilities to be screened for cancer.

Reception staff play a pivotal role in supporting people with a learning disability to access cervical screening. This guidance can help enhance the patient experience.

2.9 – Supporting Patients with Physical Disabilities

CQC GP mythbuster 104 explains that this organisation has a duty of care to ensure all eligible people have access to cervical screening. People with a disability may find it hard or impossible to attend for cervical screening. This may be because of:

  • Lack of wheelchair access
  • Problems getting onto the examination couch
  • Previous misunderstanding, dismissal and negative experiences of cervical screening.

Should this organisation consider offering cervical screening during home visits, a risk assessment will need to be undertaken for each individual patient. This will ensure that the patient is supported by other services if treatment, follow up or referral is required.

2.10 – Chaperones

The organisation must make sure it provides care and treatment that ensures people’s privacy, dignity and always treats them with respect. It is important for sample takers to check a person’s preferences about their cervical screening. This could include asking if the patient would like a chaperone even if this question has been asked at reception or promoted by posters displayed.

2.11 – Cervical Screening Results

Individuals should expect to receive their results within 14 days from the date of the sample being taken. Results are sent directly to the individual sample taker and this organisation will also be notified of the results. Patients are to be advised that there are four possible results:

Result Comment
HPV negative No further tests required
HPV positive: no abnormal cells Patient will be called for screening sooner than usual (full details will be given in the result letter)
HPV positive: abnormal cells found Patient will be referred for colposcopy
Inadequate result Patient will be asked to attend for cervical screening in three months’ time

2.12 – Recording Results

All results must be recorded in the individual’s healthcare record on the clinical system. For normal results, patients will be recalled in line with the NHS CSP. For abnormal results, patients will be managed as detailed in the cervical screening care pathway.

It is the responsibility of the nominated individual to ensure all results are accurately recorded on the clinical system using the correct SNOMED CT codes.

Failsafe Arrangements

3.1 – Overview

A failsafe arrangement is a means to ensure that, should something go wrong, there are processes in place to identify the issue(s) and timely actions are taken to resolve these thereby ensuring a positive outcome.

The failsafe process for newly registered individuals is that if the individual’s screening history has not been received by call and recall within 21 days of registering in England, a ‘failsafe’ NTDD is set.

To comply with the service specification, this organisation is required to:

  • Include appropriate failsafe mechanisms across the whole screening pathway
  • Ensure routine staff training on failsafe procedures takes place
  • Maintain a record of tests taken
  • Check that results are received from the laboratory for every sample
  • Ensure individuals whose samples they report will be notified of results (either by the organisation, the colposcopy clinic or the call and recall service)
  • Ensure the required colposcopy referrals are made and outcomes recorded
  • Ensure that the colposcopy service is responsible for informing the call and recall service regularly of the next test due date by completing the discharge template for all women discharged from colposcopy
  • Act on non-responder notifications
  • Respond to failsafe enquires from the laboratory
  • Report incidents in line with screening incident guidance

Staff Competency, Responsibilities and Training

4.1 – Training

The practice will fully comply with all requested for training and mandatory updates required by the Cervical Screening Programme.  All smear takers attend refresher training as routine.

4.2 – Sample Taker Responsibilities

Sample taker responsibilities are outline in the Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities document at Section 4.

Audit

5.1 – Requirement

There is a requirement to audit the cervical screening process within this organisation every two years. The audit will include the following information:

  • Title
  • Reason for the audit
  • Criterion or criteria to be measured
  • Standard(s) set
  • Preparation and planning
  • Results
  • Description of change(s) implemented
  • Reflections

An audit template can be found at Annex C

Annex A – Withdrawal from Programme Letter

Annex B – Disclaimer Form

Annex C – Audit Template

Breast Screening Guidance

Introduction

1.1 – Protocol Statement

The purpose of this protocol is to provide guidance for staff at Godiva Group of Practice’s in relation to the NHS Breast Screening Programme also referencing information from the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS) information. It aims to identify breast cancer at an early stage, increasing the chances of breast-conserving surgery and a better prognosis for long-term survival.

Breast screening is one of the NHS national population screening programmes available in England. To ensure the screening process remains ethical patients must receive:

  • Guidance to help them to make informed choices
  • Support throughout the screening process

It is the responsibility of all staff at this organisation to ensure they are aware of their individual and collective efforts to support the national screening programmes. This protocol must be read in conjunction with the referenced publications and NHS screening programme guidelines.

Protocol

2.1 – Aim

The NHS overview on breast cancer states that it is the most common type of cancer in the UK. Although most women diagnosed with breast cancer are over the age of 50, younger women can also have breast cancer. About one in eight women are diagnosed with breast cancer during their lifetime but there is a good chance of recovery if it is detected at an early stage.

In rare cases, men, trans and non-binary people can be diagnosed with breast cancer and the NHS overview on this area provides further accessible information. Breast cancer in those who are registered with their GP as male is out of scope for this protocol.

Staff are reminded that no screening test is 100% reliable and patients may receive false positive or false negative results. It is therefore imperative that they are advised to make an appointment to discuss any concerns they may have. This includes a family history of breast cancer and other associated symptoms.

2.2 – Patient Engagement

In line with NICE guidance, this organisation will provide appropriate information to all those registered as female with their GP from age 47 onwards. Early engagement on the screening programme will improve patients’ understanding and enable them to make informed decisions.

The available breast screening information leaflets include:

It should be noted that trans and non-binary people who are registered with their GP as female will be invited for breast screening. Trans and non-binary people who are registered with their GP as male will not be routinely invited for breast screening but can request screening. Further information can be found in NHS population screening: information for trans and non-binary people.

If the patient has a learning disability or does not have the mental capacity to decide, then they should offered An easy guide to breast screening.

2.3 – NHS Screening

Screening in England, Scotland, Wales and Northern Ireland is offered as below. It is to be noted that, in this section, where it states ‘woman’, this refers to ‘those registered as female with their GP’.

  • Woman aged 50-70 are invited for a mammogram every three years
  • In some circumstances, women outside of the age range could be screened either through self or GP referral
  • Women between the ages of 47-49 and 71-73 could be offered screening as part of the AgeX trial
  • Women older than the maximum age for screening in their area are excluded from the programme. Those in this range may continue to receive screening through self-referral

Note: Not all women will receive an invitation immediately. However they should receive their first invitation for the programme within three years of their 50th birthday.

Information on local breast screening services for the UK nations can be found below:

All eligible individuals will receive a letter by post inviting them to book an appointment by phone, email or to book online. In some cases, individuals may be given a pre-booked appointment.

Results

The mammogram (breast screening X-rays) procedure is usually completed in less than 30 minutes. Results are sent via letter to the patient within two weeks and copies are also sent to the patient’s GP. There are three types of result:

  1. Satisfactory – the mammogram showed no sign of cancer. The patient will be returned to routine three-year recall.
  2. Need further tests – the mammogram looks abnormal and may require physical examination, more mammograms, ultrasound scan or biopsy. Results in this category will usually be delivered within one week.
  3. Unclear – the mammogram is not clear enough to read (possibly due to technical problems). The patient will be invited to have a repeat mammogram.

If cancer is found, it may be either non-invasive or invasive. Further information regarding the types of cancer can be accessed here.

Opting out of Screening

This link provides information for health professionals about how, and in what circumstances, patients can opt out temporarily or permanently from breast screening.

Within the link there are also separate forms and letters that can be used should any patient wish to opt out. This includes the following:

The Role of Primary Care in Breast Cancer Screening

While the delivery of the NHS Breast Screening Programme does not directly involve primary care, this organisation can support the programme by promoting screening, providing information on the screening process and the need for the patient to attend repeat screening when invited.

Cancer Research UK advises that breast screening reduces the number of deaths from breast cancer by about 1,300 a year in the UK. Clinicians should not be over-reassured by previous normal screening results.

Bowel Cancer Screening Guidance

Introduction

1.1 – Policy Statement

The purpose of this document is to provide guidance for staff at Godiva Group of Practice’s in relation to the NHS Bowel Cancer Screening Programme which aims to identify bowel cancer at an early stage when treatment is more likely to be successful.

Bowel screening is an NHS national population screening programme that is available in all UK nations and invites individuals for screening for patients to receive:

  • Guidance to help them to make informed choices
  • Support throughout the screening process

It is the responsibility of all staff to ensure that they are aware of their individual and collective efforts to support the national screening programmes.

This document must be read in conjunction with the referenced publications and NHS screening programme guidelines. Further reading on colorectal cancer can be found at NICE guidance NG151 and DG30.

It should be noted that while this guidance document is to support bowel cancer screening, NICE guidance DG56 was updated in August 2023 to support faecal immunochemical testing for all patients who are suspected to have colorectal cancer.

Policy

2.1 – Aim

Bowel cancer is a common type of cancer in both men and women. About one in 20 people will get it during their lifetime. Screening can help to detect bowel cancer at an early stage when it is easier to treat. It can also be used to help to check for and remove small growths in the bowel called polyps which can turn into cancer over time.

The faecal immunochemical test kit, known as the FIT kit, is used for screening and will automatically be sent to the home address of eligible patients.

Staff are reminded that no screening test is 100% reliable and patients may be falsely reassured when they receive their test results. It is therefore imperative that they are advised to make an appointment to discuss any concerns they may have. This includes a family history of bowel cancer and other associated symptoms.

In addition to the screening programmes as detailed below, should patients present with suspected colorectal cancer symptoms then the care pathways as detailed within NICE guidance DG56: Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care are to be followed.

2.2 – Screening In England

Screening is offered in England as follows:

  • Patients aged 54 to 74 will automatically be sent a FIT kit every two years. The programme is expanding to make it available to everyone aged 50 to 74 years. This is happening gradually over four years having started in April 2021.
  • Patients aged 75 or over can request a FIT every two years by calling the free bowel cancer screening helpline on 0800 707 60 60
  • Patients who are worried about a family history of bowel cancer or have any symptoms must be directed to speak to a GP for advice

Guidance for patients can be found on the PHE webpage for both males and females. Furthermore, instructions in various languages on how to conduct a FIT can be found here.

Bowel Cancer Screening Process

3.1 – FIT

An invitation letter including information on the possible benefits and risks of screening followed by a FIT kit is sent to the patient’s home address. This includes instructions on how to use the FIT kit which are also available here.

This organisation will be informed of the result electronically which is usually received within two weeks of the laboratory receiving the completed test.

3.2 – Colonoscopy

A colonoscopy may be required for patients whose FIT shows they require further examination. Patients in England are automatically sent an invitation approximately two weeks before the colonoscopy. This is in letter format and includes an enema and instructions how to use it.

The whole procedure is usually completed within 90 minutes and the results are sent via letter to the patient within two weeks.

There are three outcomes:

Result Action
No polyps or cancer found This is normal so no further action required
Polyps found and removed during the test but are not cancerous ·     Patient may be offered a colonoscopy

·     Patient may be offered surgery to remove any polyps

Polyps were found, removed and found to be cancerous Patient will be referred to see a specialist as soon as possible

It should be noted that fewer than one in 100 people are found to have cancer and for those that do, there is at least a 90% chance of survival should the cancer be found and treated early.

Further Reading and Guidance

While the delivery of the NHS Bowel Cancer Screening Programme does not directly involve primary care, this organisation can support the programme by:

  • Promoting the update of screening
  • Providing information on the screening process and the need for repeat screening when invited

Further reading and patient information resources are available from the following:

Region  
UK NICE guidance NG151: Colorectal cancer

NICE guidance DG56: Quantitative FIT to guide colorectal cancer pathway referral in primary care

Cancer Research UK

Bowel Cancer UK for over 60s and over 55s

Various

England NHS guidance
Scotland NHS Inform
Wales Bowel Screening Wales
Northern Ireland HSCNI Bowel Cancer screening

Blood Test Protocol

Introduction

1.1 – Policy Statement

To provide a standardized approach for requesting, reviewing, and actioning test results, ensuring timely and effective communication with patients while maintaining confidentiality and accuracy.

1.2 – Scope

This protocol applies to:

  • All clinical staff, including GPs, nurses, and healthcare assistants.
  • Administrative staff managing test bookings and results communication.
  • Tests such as blood work, imaging (x-rays, scans), and other diagnostic procedures.

Whenever a doctor orders a test, Patient will be referred to the Phlebotomy services as practice does not provide this service.

Phlebotomy service should advice patient to contact practice in reasonable time depending on test carried out, most blood, urine and faecal (poo) tests are usually back within 2 weeks.  Other tests can take longer. So, if the patient has had several blood tests done, please advice them to call back in 2 weeks time when the result will be actioned by a clinician.

Clearly, you don’t obey the 2 week rule if the blood test is marked urgent – like a D-dimer – in which case they are usually back after 48 hours (2 days). The results usually come back to us electronically down what we call Pathlinks.  Often, it will go to a specific doctors inbox – but the reception staff can log in and allocate it to a different doctor (for example – when the doctor is on annual leave, or to distribute the results more evenly across all the docs).

1.3 – Responsibilities

General Practitioners (GPs):

  • Review and interpret results.
  • Make clinical decisions based on findings.
  • Ensure appropriate follow-up and documentation.

Nurses/Healthcare Assistants: (patients are referred to phlebotomy clinic)

  • Conduct initial tests (e.g., phlebotomy).
  • Support patient preparation and guidance.

Administrative Staff:

  • Ensure test requests are processed correctly.
  • Monitor incoming results and flag unfiled results.

Procedure (Doctors)

2.1 – When Requesting a Blood Test

  • Doctor documents during consultation in the new journal about blood test requirements
  • Doctor should inform patient about any additional requirements for the blood test – e.g. fasting, morning sample for U&Es etc.
  • If urgent bloods are required that day, it is the doctor’s responsibility to direct the patient to the phlebotomy services.
  • Doctor opens up pathology and radiology link (TQuest) and orders the blood tests directly from the ICE server, fills in the clinical indication and ticks the box to collect the sample later.
  • If TQuest is not working, please enter the blood request in the new journal. Patients can not amend the request form, if they do it will be rejected.
  • It is good practice to detail the clinical indication thoroughly.
  • If a doctor arranges an urgent test, it should be clearly documented in the notes and it is the requesting doctor’s responsibility to ensure that the results are acted up on e.g. D-dimer

2.2 – Filing Blood Results

  • Results are looked by GP Automate (AI). Normal results will be filled in patients notes and a message will be sent to patient.
  • Doctors are required to file all blood results within 5 working days(this includes the weekdays you may not work)
  • It would be good practice to at least glance at your results during every working day, because some significantly abnormal results requiring prompt action may arrive down the pathlinks
  • It would also be considered good practice to read the new journal before filing results, so that you can check the indication and clinical circumstances and relate these to the result.
  • In certain situations, it may be appropriate for a GP to reassign the results to the requesting GP. Please use your discretion

2.3 – Actioning Blood Results

Abnormal results will be reported on by the doctor using the EMIS Web tasks system.

If a test result is normal and requires no further action, it will be ‘filed’ as “no action required”.  Admin staff will be able to see the ‘normal’ result filed within the patient’s record should they ring up and enquire. GP Automate action all the normal results and send a message to patients.

Some results will be abnormal and require specific action. For these sorts of results, the doctor will send an ‘action task’ to the ‘Admin’ group within EMIS Web before filing the result.  The action might be…

  • To make an appointment with Doctor
  • To make an appointment with Nurse
  • Re-refer to new test/different test or repeat test etc.

The admin member of staff will then contact the patient to implement this requested action.  This process means that the practice takes pro-active action in contacting all patients who have ended up with an abnormal result, whilst implementing the requested doctor’s actions without the need for all patients to see the doctor again (and hence use up valuable doctor consultation time).

When filing results you usually have 4 situations:

  1. “Normal” Results requiring no action
    • File as “normal”, with “no action needed”. Message is sent to the patient by GP Automate (AI)
    • Just be careful with normal HBA1Cs in Diabetics who are on insulin – they could be having hypos – go into records and see if they need a review.
  2. Slightly abnormal results that you are not worried about (eg slightly low eGFR but stable for years)
    • File as “satisfactory”,  with “no action needed”
    • Leave a note in the comments box, if you feel it would be helpful – e.g. “your thyroid blood tests are fine, repeat again in 6 months”, “you’re kidneys arent working as well as when you were younger.  But this is normal and your kidney tests show yours is stable and nothing to worry about.”
  3. Slightly or Significantly abnormal results requiring routine action
    • File as “abnormal”, with the appropriate action selected
    • The doctor should aim to be proactive; task the “results” team to contact the patient with a message – e.g. “your blood tests show that your liver tests have slightly gone off.  Nothing to worry about at this stage but it is important to get a repeat liver test in 2 weeks time”
    • Make sure you include a time frame with any suggested action eg within 2 weeks, within 4 weeks, do not write “2-4 weeks – that is confusing – 2 weeks or 4 weeks? – how can a patient decide?
    • If the admin team are unable to contact the patient about a routine task by telephone, a standard letter will be sent by post. If this is not appropriate, the doctor should mark the task as urgent with a red flag.
    • It is good practice to write something in the new journal for good continuity of care
  4. Slightly or Significantly abnormal results requiring urgent action (e.g. results phoned through by the lab)
    • File as “abnormal”, with the appropriate action selected
    • It is the doctor’s responsibility to action these results immediately – you may need to call the patient directly yourself eg an anaemia of 6.5
    • If you are unable to contact the patient, please speak to the admin team or the on-call doctor according to your discretion.
    • Of course, you can task the “RESULTS” team and “red flag” the item – admin team always work on the red flag messages in their inbox before working on the routine.  For example, red flag the following message “You’re blood tests shows that you have become anaemic.   Please come and see the doctor within 1 week to assess you.  This is important.”

Procedure (Admin)

3.1 – Routine Tasks

  • When admin are processing patient messages in the ‘results’ task group they should try and contact them by phone at least twice at different times.
  • If they are unable to get hold of the patient they should compose a letter by copying and pasting the doctor’s message.
  • If it doesn’t seem appropriate to include the doctor’s message, admin can send a generic letter asking the patient to contact us regarding their results.

3.2 Urgent Tasks (Red Flag)

  • Remember – red flag tasks are urgent things – work on these before any of the others.
  • Try to contact the patient by telephone within 2 working days
  • If unable to contact the patient, please inform the GP who sent the task or the on-call GP, if the other GP is unavailable.

3.3 – If patients contacts you regarding test

If the result are not back

  • Determine whether it has been 2 weeks since the test was done.
  • If it less than 2 weeks,  explain to the patient that results usually take 2 weeks to come back and therefore to ring again after this time.
  • If it has been more than 2 weeks, explain to the patient that the result is not back from the labs. Apologise for the delay and that you will personally chase this up and get back to them within 24-48 hours. Ring the lab and chase the result.  Once you’ve managed to get the result back, show it to a doctor (preferably the requesting doctor or the on-call doc) to get a professional interpretation of the result and what to say to the patient.  Then, ring the patient back.
  • Do not put any of these down for a telephone consultation/call with the requesting doctor nor the emergency on call doctor.  Sort the problem out yourself first.

If the result are back AND has been reported on by a doctor 

  • Give the test result – try and use the words the doctor has written.
  • If the interpretation is not clear – ask that doctor for clearer advice (rather than risk giving the patient the wrong information)
  • Ask the patient if there were any other tests that were done

If the result are back BUT has not been reported on 

  • If it is less than 1 week since the test was back, advise the patient that the test is back but that the doctor will be shortly going through them. Advise them to ring again in 1 week and explain that this should give the doctor some time to report back on them.
  • If it is more than 2 weeks since the test was done, apologise for the result not being reported on. Tell them that you will personally chase it up and get a doctor to take a look within 24h and get back to them.
  • Get in touch with the doctor who is meant to have reported on the result – ask them for an interpretation.  You can send a EMIS Web Task to do this, although it is probably much easier and quicker to ask the doctor in person when they are at their computer screen.
  • Get the doctor to comment and ‘file’ the report within EMIS.
  • Then call the patient back and explain the result.

Communicating Results to Patients

4.1 – Method of Communication

  • Use the patient’s preferred method (e.g., phone, email, patient portal).
  • Document the communication in the patient’s record.

4.2 – Confidentiality

  • Verify the patient’s identity before sharing results.
  • Avoid leaving sensitive information on voicemail or with unauthorized persons.

Minor Surgery Policy

Policy Statement

Godiva Group of Practice’s has signed up to the Minor Surgery Scheme outlined in the Primary Medical Services (Directed Enhanced Services) Directions 2023 (please see document). This Directed Enhanced Service has been established to support the local population so that they can more easily access surgical procedures that can be undertaken within the community. Throughout this document, ‘minor surgery’ and ‘joint injections’ are simply referred to as ‘minor surgery’ but can relate to either procedure.

Service Delivery Specification

1.1 General Requirement Specification

The aim of this agreement is to ensure that practices have the opportunity to provide a wider range of minor surgery procedures within a primary care setting.

This Enhanced Service sets out the process for practices to:

  • Undertake minor surgical procedures for patients from their own practice
  • Monitor minor surgical activity
  • Must record in the patient’s record: (a) details of the minor surgery provided to the patient and (b) the consent of the patient to that surgery

To access the consent form please use template within patient record “Minor OP – Consent Form”.

2.2 – Eligibility for Minor Surgery

Minor surgery at the practice is generally available for conditions such as:

  • Removal of cysts, skin tags, and small lumps
  • Incision and drainage of abscesses
  • Joint injections for pain relief

Before any procedure, a clinician will assess your condition to determine whether minor surgery is suitable for you or if a referral to a specialist is necessary.

2.3 – Duties and Responsibilities

Dr P Bahalkar is the nominated clinician who is the lead for minor surgery within this organisation and they are responsible for ensuring that the organisation’s minor surgery and joint injection standards meet national and local policy/guidance or best practice.

2.4 – Pre-Procedure Guidelines

Consultation: Before surgery, you will have a consultation with your clinician. They will explain the procedure, the risks involved, and what to expect.

Consent: You will need to sign a consent form before the procedure. This confirms that you understand the risks and benefits and agree to proceed.

Medical History: Ensure you inform your clinician of any existing medical conditions, medications, or allergies.

Fasting: In most cases, fasting is not required for minor surgery. However, your clinician will inform you if specific preparation is needed.

2.5 – The Procedure

Minor surgeries are typically done under local anaesthesia, meaning you will be awake but the area being treated will be numbed.

Procedures usually take between 15 to 45 minutes, depending on the complexity.

A sterile environment will be maintained to minimise infection risk.

2.6 – Post-Procedure Care

Wound Care: After surgery, you will receive instructions on how to care for your wound, including cleaning and dressing.

Pain Relief: Over-the-counter painkillers, such as paracetamol, can help manage any discomfort. Avoid aspirin unless advised, as it may increase bleeding.

Follow-up: You may need a follow-up appointment to monitor healing or remove stitches if applicable.

Signs of Complications: Watch for signs of infection (redness, swelling, warmth, or discharge). Contact the practice if you experience fever or excessive pain.

Governance

3.1 – Record Keeping

A full record of the procedure should be made in the patient’s electronic record and should include:

  • A SNOMED CT coded entry of the operation undertaken
  • Anaesthetic used
  • Any medication used
  • Suture material – type, needle used, make, batch numbers and expiry dates

3.2 – Audit

Full records of all procedures should be maintained in such a way that aggregated data and details of individual patients are readily accessible. The Practices should regularly audit and peer review minor surgery work.  Possible topics for audit include:

  1. Clinical outcomes
  2. Rates of infection
  3. Unexpected or incomplete excision of lesions which following histological examination are found to be malignant

3.3 – Training

Clinicians providing this Enhanced Service will have had sufficient surgical training either by previous experience in general surgery or through a relevant post-graduate qualification, for example:

  • Certificate of Competence in Minor Surgery from a Vocational Training Scheme
  • Higher degree or diploma in a surgical specialty
  • Evidence of completion of an approved course of training in minor surgery

Identification Of Carers Policy

1.1 – Definition of a Carer

Carers are people who, without payment, provide help and support to a family member, friend or neighbour who cannot manage on their own due to physical or mental illness, disability, substance misuse or frailty brought on by old age.

Caring roles can include administering medication, lifting and handling, personal or emotional care. Carers should not be confused with paid care workers, care assistants or with volunteer care workers.

A “young carer” is defined as being someone below 18, who carries out significant caring tasks and by so doing, shoulders a level of responsibility for another person which is inappropriate for their age.

This situation often arises when parents who have long term conditions are not offered appropriate help and support, although it is a fact that most children of disabled or sick parents do not have to take on such responsible caring roles.

The person receiving care may, or may not be registered at the carer’s practice. When this situation arises, because the practice will not be always be able to ascertain that the carer / patient relationship has ceased, the carer may be asked to re-confirm their carer status.

Where the person receiving care is a registered patient at the carer’s practice, the carer / patient relationship can be verified more frequently, resulting in practice-held information being able to be modified when significant events such as death or de-registration occur.

Many carers may not identify themselves as a carer. Instead, they see themselves as someone’s partner, relative or friend who is simply ‘doing their best’ to help someone they care about. For this reason, asking ‘do you look after someone?’ can be a more effective opening question than ‘are you a carer?

1.2 – Significance of Identifying Carers

This organisation will use the NHS England Carers toolkit which provides detailed guidance on how the organisation can identify and support the wellbeing of carers and their family. Furthermore, by effectively identifying and appropriately supporting carers, this organisation can make sure carers are able to lead a positive life outside their caring role.

1.3 Mechanisms for Identifying Carers

This organisation uses two methods to identify carers – self-identification and organisational identification. Self-identification is reliant on individuals informing staff that they are carers.

Organisational identification uses the following methods to raise awareness of the support available to individuals:

  • Displaying posters in the waiting room and clinical areas
  • Including a carer section on new patient registration forms
  • Promoting carer information on the organisation website and other social media
  • Placing carer registration forms at reception (see Annex A)
  • Holding carer campaigns and events using local media, social media and a range of other opportunities.
  • When an individual is collecting a prescription on behalf of someone else
  • During a discussion with a patient in consultation or other opportune times

All staff have a responsibility to try to identify, support and signpost carers.

1.4 Recording Carer Details

Staff are to ensure that carers are correctly coded on the clinical system using SNOMED CT code: Caregiver (person) SCTID: 133932002, Carer – ub1ju, Has a Carer – 918F, No longer a carer – Y3222.  Furthermore, individuals identified as carers will be added to the carers’ register and an alert added to the clinical system to ensure whole team awareness.

1.5 – Support to Carers

To ensure carers are identified and supported effectively, this organisation will adhere to the NHS England Supporting carers in general practice: a framework of quality markers.

1.6 – Carers Champion

There is a nominated Carers Champion at this organisation and it is their responsibility to take the lead on all carer-related matters, providing advice and direction to staff and patients as required. Furthermore, they will gather evidence and complete the declaration at Appendix B of the framework of quality markers.

1.7 – Additional Resources for Carers

Additional services and agencies to which carers can be signposted are:

Annex A – Carer’s Identification Form

Home visit Policy

1.1 – Home Visit Request

Requests for home visits are received via telephone (usually between 0800 and 1200). They are triaged by a clinical member of the team and recorded on the clinical system. Requests received outside of these times are to be referred to the duty doctor. Non-urgent home visit request are booked next day, if slots are not available.

When discussing with the patient their condition, it is essential that the following are confirmed:

  • Patient’s full name (if not the patient, full name of the person calling, relationship to patient and that consent has been provided)
  • Date of birth, Address and Contact telephone number
  • Known existing medical conditions
  • Reason for calling/duration of symptoms
  • The patient or carer is to be reminded that staff are not to be unduly exposed to risks.

Risks may include:

  • Moving throughout the premises
  • Animals
  • Second hand (or passive) smoking
  • Any other obvious risks that may cause harm to the employee

In addition, the name, address and telephone number of the next of kin, a family member or nearest keyholder should also be considered in case of a failed visit.

2.2 – Home Visit Justification

Home visits are at the discretion of the GP who will determine if the visit is clinically necessary. Visits are reserved for patients who are genuinely housebound, including those in nursing and residential homes, and terminally ill patients.

A healthcare professional from the organisation may conduct a home visit if they believe the patient’s condition:

  1. Prevents them from travelling to the organisation, or
  2. The condition may deteriorate as a result of travelling to the organisation

Home visits will not be authorised because of:

  1. A lack of transport
  2. The patient’s financial situation
  3. Childcare issues
  4. Poor weather conditions
  5. Any other situation deemed inappropriate by the clinician

This organisation will also consider whether alternative ways of assessing the patient are appropriate such as either a video call or a telephone call or, if in a care home, the use of a virtual ward.

2.3 – Patient Obligation and Managing Risks on a Visit

This organisation has an obligation to our staff when visiting any patient’s home and would expect that they are not exposed to risks. While there is no law to protect anyone working in a patient’s home, the organisation would rely on their understanding and goodwill to ensure that the healthcare professional is not unduly exposed to risks during their employment. Not being exposed to risk is an absolute right and should the staff member feel compromised, then this organisation will fully support their decision in all circumstances.

Following any visit, should the staff member be concerned, or have highlighted that the patient’s home is potentially hazardous to their own or others’ health or safety, then a patient contract can be raised to formalise the arrangement. A template contract is available as an annex within the Dealing with Unreasonable, Violent or Abusive Patients Policy.

Expectations would be that the consultation area is smoke free, there is a space to safely enable the clinician to undertake their role, or that any animal that is likely to cause a nuisance is not in the same room for the duration of the visit.

Any risk and mitigating actions are to be recorded using the template at Annex A shown below.

Details of any contract, risk management or significant event should be detailed within the clinical system, enabling any visiting healthcare professional to view potential risks.

Should there then be non-compliance with this agreement, then the member of the team will need to determine how to proceed on the day. As this organisation has a duty of care to both patient and staff, the ICB is to be consulted to discuss the next steps. This may include requesting that any visits are conducted at an alternative venue. The Defence Union and/or LMC may also be contacted for advice.

2.4 – Home visit Management System

The flow diagram shown below in Annex B illustrates the processes that are to be adhered to for home visit requests.

Annex A – Home Visit Risk Assessment

Annex B – Home Visit Management System

Did Not Attend (DNA) Policy

Policy Statement

The purpose of this document is to provide guidance regarding the management of patients who fail to attend their appointments. It is essential to make the best use of the clinicians’ availability to ensure that all patients have access to appointments within an acceptable time frame.

Policy Overview

When a patient fails to attend an appointment or fails to notify this organisation 24 hours prior to the scheduled appointment of the need to cancel or change the appointment, it is referred to as a Did Not Attend (DNA) or Was Not Brought (WNB).

If you cannot attend your allocated appointment, please contact us to cancel the appointment. This is so the appointment can be offered to another patient.

Appointments can be cancelled via either calling the surgery or by using the NHS App