1. Trinity Park GP Training Event Referral Audit Update 12 th November 2015 1 Dr John Oates – IESCGG Clinic Executive Dr Paul Bethell – IESCCG Clinic Executive (Planned Care lead) Nerinda Evans – IESCCG Associate Director, Planned Care

2. Referral Audits The Clinical Transformation Group (CTG) process requires that referral audits were undertaken to ensure due diligence. These were planned for Orthopaedics, Urology and Gastro. Further audits have been requested for specialties including Physiotherapy, Rheumatology and Neurology. These specialties have been showing raised first OP activity for three consecutive months. Ophthalmology is also showing high activity but audits were completed a long while back and the issues are already being addressed. Five audits have been completed so far:- GP referrals to Rheumatology GP referrals to Orthopaedics General referrals to Urology 2 x General referrals to Gastro (Jul & Oct 2015) Further audits are planned including:- A&E referrals to Orthopaedics (completed – Awaiting analysis) Orthopaedics (specifically C2C) Physiotherapy (specifically C2C) General referrals to Neurology Pathway compliance to Wet AMD (Ophthalmology) pathway 2

3. Orthopaedic Audit results 13-10-15 63 referrals audited, 67% from GPs with 62% by letter and 2% by eReferral Majority for Hip, Knee and Spinal issues Unless a Red Flag condition all referrals to be sent to the Community Physiotherapy service. (Spinal, Upper, Lower Limb) Identified that at least 43% of referrals could have been handled in primary care Many more requests for Expert Opinion, make more use of Advice & Guidance GP Registrar, Nurse Practitioner & Medical Secretary referrals should be checked by GPs Make more use of eReferral (faxes cease 1/12/15) Referral forms missing key information 3

4. Urology Audit Results 20-10-15 70 referrals audited; 81% from GPs with 46% by letter and 39% by eReferral 17% females / 83% male Majority of referrals were for Expert Opinion Male LUTS has significant potential for reducing referrals as many examples of the p/way not being followed e.g. –PSA testing not completed (variable thresholds for referral) –medication not tried at all, –prostate not examined Variable work up - Half of referrals did not have the necessary pre-referral tests/investigations Nurse practitioner referrals could be triaged by GP as several examples of premature referrals, and pathway not followed There were several minor conditions where ADVICE & GUIDANCE could be used :- –For children Phimosis, Undescended testicle, Balanitis –For adults Hydrocele, Haematospermia, ED, Epididymal cysts, Testicular pain, Peyronie’s Conditions that need a pathway –Recurrent UTI’s (young women + eldery (M+F) – Frequent referrals with variable work up –Raised PSA pathway (variable thresholds for referral) –Microhaematuria Other issues & Ideas –Community Ultrasounds are generating referrals –C2C referrals don’t follow the pathways e.g. LUTS –Consultants should reject incomplete referrals –In general referrals not worked up as should be –Could C2C referrals be handled better. (Rather than encourage a 1 st OPA rather have internal A&G or ALL) –Set up a Trial Without Catheter (TWOC) clinic? –Set up a catheter problems clinic 4

5. Gastro Audit(s) – July 15, Oct 15 98 referrals in total audited, 85% from GPs with 46% by letter and 39% by eReferral Half of referrals were for Expert Opinion – Use of Advice & Guidance to reduce referral rate One third of referrals did not have their pre-referral guidance or tests / investigations correctly completed prior to referral A significant number (nearly half) of the referrals could have been managed in either primary care or at alternative services such as dietician / direct to CT or General Medicine Other issues & Ideas –Need for outreach hepatitis service 5

6. General messages All MSK referrals via Community Physio Consider if Advice and Guidance can be requested prior to a referral Pre-referral guidance needs to be completed in full – See Map of Medicine Several duplicate referrals found Check referrals before they leave the practice Consider right specialty first time Make use of eReferral where possible (faxes cease 1/12/15) 6