Primary Care Alternatives to Referral

Primary Care alternatives to referral

Has the case been discussed with GP colleagues within the practice who may be more experienced in managing this type of problem?

Do you have a list of subject areas against each GP in the practice and is this shared with Registrars and Locums?


Would Advice and Guidance be more appropriate than OPA?

Using Advice and Guidance or writing direct letters to consultants are quick and can be requested instead of booking a clinic appointment on eRS.  Neither incurs any cost to the CCG.


Referring in the patient’s best interests

Have you discussed the benefits and risks of further investigation , treatment and doing nothing?  Choosing Wisely is a national campaign by the Academy of Medical Royal Colleges which encourages  better shared decision making. 


Are there mental health/anxiety issues that could be reduced with CBT?

IAPT takes self referrals (Tel 01423 852137) as well as GP referrals.  IAPT has a team who work with patients who have anxiety and/or depression related to their long term conditions (please highlight long term conditions on the referral form)


Could this be a Procedure of Limited Clinical Value or is there local guidance?

All local PoLCV and other local pathways can be found here


Does Health Optimisation apply (BMI >30 or smoker and potential referral to surgical specialty)?

All information about Health Optimisation (FAQs including GP evidence briefing) can be found here.  Patient leaflet can be found here


Is the patient lonely or isolated and needing more support?

Living Well team for patients who need more support. Self refer 01609 780780 Option 2 for social care
Connecting for Wellbeing for patients who are isolated and need to get more connected with their community.  Use Active Health and Wellbeing form or self  refer 01423 500600 x58206
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Is this a musculoskeletal condition? Self care resources are available here. Have you considered physio before thinking about MSK or ortho?  Physios discuss difficult cases with MSK colleagues.  For OA of hip and knees and low back pain they also run an education class (put ‘OA or LBP education class’ on the referral form) . Local musculoskeletal pathways can be found here

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