1. NHS South Tees CCG Rapid Specialist Opinion (RSO)
Right Care, Right Place

2. Introduction
New process launches on 1 November 2017
Accessed through GP Clinical system using the e-Referral Booking Service (Choose & Book)
The RSO has a duplicated Directory of Service on e-Referral for each choice of provider, in each speciality and clinic available.
The process requires practices to submit a referral to the RSO via e-Referral System (e-RS). This will generate a dummy appointment which will be converted to a real booking should the patient require a hospital appointment.
The RSO uses existing guidelines to ensure that onward referrals is the most appropriate next step for care and treatment.

3. The process is to be followed for 10 Specialties:
Orthopaedics
ENT
Dermatology
Cardiology
Gynaecology
Ophthalmology
General Surgery
Neurology
Urology
Rheumatology
To be used for all Routine and Urgent referrals
Excludes 2ww referrals and very urgent
Very Urgent = life threatening, same day assessment
Urgent = not a suspected cancer diagnosis but symptoms or suspected diagnosis that needs specialist input within 2/3 weeks, that will not wait 18 weeks

4. Implementing RSO in Primary Care

5. Step 1 – Decision to refer
GP or Nurse Practitioner makes decision to refer to secondary care
Message to patient ‘I’m going to seek the advice of a specialist’. Provide patient leaflet
Referrer undertakes choice conversation with patient should they need to see a consultant (choice of provider ie which hospital or clinic the patient chooses) and records choice to be included in the referral letter
The outcome of the referral may be either that the patient needs to be seen in hospital (in this case they will receive an appointment by post) or that they may be contacted by the practice for follow up treatment and management.
NB In the RSO process patient does not receive any appointment information from the GP practice.

6. Step 2 - Submitting the referral to RSO using e-Referral
NB: Practices may wish to consider creating the UBRN at the time when the referral letter and other required information is ready. Practices should have a process in place to ensure that every intention to seek specialist opinion is actioned as soon as possible to avoid patient delay in treatment.
Enter e-RS through the clinical record. Select relevant Speciality and Clinic Type. Select ‘Search Primary Care’. Select the RSO duplicate of the patients choice of provider service if not available use any provider and clearly specify choice of provider in the body of the referral letter.

7. Step 3 – Searching for a dummy appointment
To create the ‘dummy’ appointment click Appointment Search

8. Step 4 – Booking the dummy appointment
Select and book available appointment slot. This is a dummy 1 minute appt that enables the RSO to see the referral letter and documentation.
Do not give the patient details of this appointment.
Tip: choose the 4th or 5th dummy appt to prevent the slot from timing out.

9. Step 5: Submitting the referral
Click Submit Referral

10. Step 6: Close appointment summary
To save in clinical system click ‘Close’
Attach the referral letter and documentation to the UBRN through the clinical system.
Any lab results and diagnostics should be included in the letter.

11. What happens next?

12. The referral has now passed on to the RSO.
The RSO Consultants and GPs with Special Interest carry out clinical triage against CCG agreed clinical guidelines within 2 working days.
2 outcomes:
Referral sent back to GP via e-RS with clinical advice on how the patient should be managed e.g. request for further diagnostic tests or to be managed in primary care. GP practice to inform patient if outpatient appt is not required and initiate alternative follow up as advised or GP practice to facilitate request for additional information to enable triage.
Onward referral to Secondary Care is managed by the NECS Booking Team (who will issue appointment letter or defer to provider letter if no appointments available). All patients will receive a letter from the NECS team with their Unique Booking Reference Number (UBRN) & Password. The appointment can be rearranged if not suitable.

13. Defer to Provider Letter
The patients choice of provider will contact them to arrange an appointment

14. Booking Letter
If appointment date and time is unsuitable patient can re-arrange via or phone
Patient Transport can be arranged by contacting Transport Information Service

15. Step 7: Primary Care Worklist Management
The worklist Referrer Action Required should be checked daily for any referrals sent back and actioned accordingly. GP practice to inform patient if outpatient appt is not required and initiate alternative follow up as advised.
If additional information is required it should be attached and returned as soon as possible to enable triage and prevent delay in any patient treatment
Accepted onward referrals are also shown within the worklist.

16. Management of Urgent Referrals
NOT 2ww Referrals or very urgent (outside of RSO)
All urgent referrals to go through RSO
RSO – Consultant will review in 48 hrs
The NECS Booking Team will escalate the urgency if the situation arises
GP to contact the consultant on call/discuss case if admission is likely – not to be referred through RSO

17. Contact:
Any queries/issues regarding the patients referral/booking/appointment contact the NECS team in the first instance using the address (same day response)
NB practices can track the referral using the ‘Patient History’ within e-Referral, the UBRN will stay on the worklist for 180 days if not actioned. It will drop off the worklist the day after the appointment date
For queries regarding triage advice contact About Health or call

18. Additional Information
A practice handbook including FAQs
Clinical guidelines available on MembersZone and Ardens
RSO Flowchart
Patient leaflet and FAQs
Any queries regarding local implementation of RSO refer to