Ask GPR - Any problems with referrals
Compile a list of quality markers e.g.
Legible. Dictation clear. Date.
What you want
What your patient wants
Urgent/routine/2 week rule
Clinical Findings. Suggested diagnosis.
Private/NHS
Recorded on computer
Please and thank you
Checked and signed
Agreed Failsafe system with patient e.g if you have heard nothing in 4/52
H/O Presenting complaint
PMH including information that is occult e.g. recently bereaved
Drugs. Allergies
Computer printout as appendage

How to teach - Referrals

Do an audit/referral analysis.

NB X rays/physio/District Nurse/HV/CPN etc.

Follow up on diagnosis & usefulness of referral

1 in 20 consultations generate letter to 2º care.
1 in 5 generate something e.g. investigation
2.9 à11.8 per 100 consultations in literature

Reasons for referral
and other tips
- asking a question
- requesting an investigation or procedure
- attempt to define limits of intervention & clarify what can be done in community

How to teach - Referrals

Why refer
Impact of disease on patient e.g. work affected
2nd opinion requested by doctor or patient
Intolerance of diagnostic uncertainty
Patients (and doctors!) social and psychological history/expectations
Doctors knowledge
Availability and accessibility of service

Remember clarity required if 3rd party request for referral - it may be necessary to ask the patient's permission.

Referrals back to GPs from 2º care e.g. discharge letters.
Complain if they are bad
Give them to the correct doctor - original referer
Act on them
Copy them to others in PCT e.g. H.V.'s

Nasty surprises - discuss as a team.