1. ENT Referrals – IQSP Day 20 th May 2014

2. Why ENT… Referral rates high Mostly first appointments WRH keen to reduce and help out Embrace the offer and keenness from the WRH!!

3. What…. Initial discussions with Steve Lewis – keen to help out Audit of referral letters: Definitely WRH Primary care treatment Middle ground - GPwSI

4. Audit results

5. Referral type

6. Reasons for referral (top 16)

7. Conditions that need to be dealt with in secondary care…. Neck lumps Malignancy Microsuction Tongue tie Acute admission – uncontrolled epistaxis, tonsillitis, quinsy

8. Snoring No longer an ENT problem

9. Rhinitis

10. Tinnitus

11. Reflux

12. Epistaxis

13. Dizziness

14. Conductive Hearing Loss

15. Primary care conditions Snoring Rhinitis Chronic sinusitis Deafness Reflux

16. Some thoughts Good primary care Appropriate referrals (80% sinus referrals had surgery or Ix – CT) Glue ear well managed in primary care Guidelines – tonsillectomy done Small numbers could more be done in primary care?

17. Possible primary care conditions Tinnitus Dizziness Could this be delivered by pathway design?

18. Reflection My initial thoughts ….. – Very good primary care – Appropriate referrals – However more could be done in primary care – Opportunity to develop the service

19. Thinking time What could be done in primary care now What could be done with more specialist knowledge Which areas for pathway redesign Which areas would you want more guidelines on