Our Referral Triage service provides the immediate capacity of ‘virtual’ NHS consultants from our National Consultant Network (NCN) working remotely as part of a local team, allowing on the ground consultants to focus on treating patients.
Dr Patrick Davey is a part of our NCN of NHS Cardiologists, answering Advice & Guidance requests from GPs across the UK, and also works on our Referral Triage service:
“I set high thresholds for patients to be seen, whereas individual consultants may set variable thresholds, some are very high, however, others will want to see most referrals. I believe that I am a good filter and minimise unnecessary outpatient attendances whilst maintaining patient safety. This helps reduce the waiting list, which is a key NHS priority.”
2. Patient ‘sort-out’ and clinical validation
“If I reject a referral, I will write to the referrer explaining why, offering Advice & Guidance as well as an alternative solution for the patient (for example, a specialty clinic more suited to see the patient, or a strategy and treatment plan to support the GP manage the patient in primary care).”
“I grade all the referrals the morning after they have been put onto the system. This means the door to grading time is about 12 hours. Many consultants will grade the referrals in the middle of a busy job, and it may be low down on their list of priorities, which often results in delay to validating the referrals.”
4. Freeing up of local consultant time
“I spend about 40 hours per month on grading referrals; these 40 hours are freed up for on-site consultants to see patients they need to see.”
5. GP education
“There are clinical issues that lead to frequent referrals, which can best be managed by GPs as they are unlikely to be serious. The commonest of these are palpitations (awareness of one’s own heartbeat). Where appropriate, I send GPs further information on how to manage these safely in primary care. This minimises load on the outpatients while maintaining patient safety.”
6. Auditable trail
“The computer system allows an easily auditable trail, and this means that acceptance threshold can be altered if appropriate in light of this data.”
7. Improving the quality of referrals
“Although many GPs refer appropriately and with full data, there are also many GPs who refer with inadequate data (e.g. no ECGs, inadequate clinical assessment, poor comorbid factor information etc). When the data provide is inadequate, I write to the GPs asking for the missing information.
For example, the ECG is a vital investigation in cardiology and key for those carrying out triage to see. When I started doing triage, relatively few referrals had ECGs. Now after feedback from me most do. Not only has this improved the quality of referrals, but it also allows better and safer grading of urgency. On several occasions the attached ECG has shown an immediately life-threatening problem requiring immediate admission and treatment, and this may not have happened without me emphasising the value of ECGs with the referral letter.”
“As an experienced clinician I believe that I am perhaps more aware of the differential diagnosis of referrals, and therefore better able to provide a safe service. Some junior consultants may have a narrower approach to diagnosis, and this may impair safety.”
9. Rapid sort out of life-threatening problems
“I have great clinical experience, and so believe that when I see referrals with potentially life-threatening problems, I am able ‘to run’ with the problem and quickly and effectively treat them i.e., immediate admission for pacemaker, early rapid assessment of decompensating aortic stenosis (narrowed aortic valve, this can lead to sudden death).”
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