CQC Visits and managing/tracking hospital referrals
Primary Care IT understands that during recent CQC inspections, questions have been asked about how practices are actively monitoring patients on waiting lists for hospital treatment. This is soft feedback from practices who have recently had inspections, and there is currently no formal guidance, nor has the CQC addressed any expectations in their very helpful Mythbuster series.
It would seem that referring clinicians safety netting by telling the patient to contact the surgery if they have not heard anything within x weeks - or if their symptoms have deteriorated - is not sufficient in the eyes of CQC.
NHS England has published a guide: The interface between primary
and secondary care
Key messages for NHS
clinicians and managers and the BMA has guidance on how Primary and Secondary care should work together for the benefit of patients. Neither of these resources has any information about this specific issue. There are useful resources for patients from the NHS here about waiting lists and here about referrals in general.
A review of the literature around this seems to indicate that under the current legal framework, it is a commissioner's legal duty to ensure that patients are seen within the timeframes set out within the constitutional standards (evidence here in Annexe A).
So in summary there is no published regulatory, NHSE, BMA, or other guidance around this issue and the legal responsibility seems to rest with the commissioning organisation.
From a practice point of view, it is incredibly hard (if not impossible) with current systems to track each referral and ensure that this has been closed off. The foundation clinical systems themselves do not have this as a core capability, and any attempt to track referrals and duration of wait would rely on accurate coding of both referral and outcome (ie: seen in clinic). Even this is fraught with so many difficulties as to make it impossible to administrate because if a patient has had more than one referral, there is no way to correlate which clinic appointment related to which referral. Indeed the only way to accurately track a referral would seem to be the e-Referral Service. However this is also fraught with difficulties. In several of our senior clinical team's regions, e-RS referrals are marked as "deferred" with no slot available when received and then a manual process for allocating an appointment is entered into. So even the data within e-RS can be unreliable.
Remember the e-Referral service is designed to be patient facing as well as for referring clinicians
What should we do
Raise the issue at a practice meeting so it has been discussed and there is a documented discussion and audit trail within the practice of it being discussed. Utilise the above links to factor into the conversation. Review your current processes, data that is available to you as a practice that you could potentially use to track patients during the referral process, recording the pitfalls or pros of each approach. Take a measured decision once all risks and benefits are known as to the practice is approaching this issue. Part of this approach may be to communicate with your patients via your usual channels (newsletter, email, poster, social media) about support available whilst on a waiting list - we've collated some of these resources below:
Resources for patients awaiting referral
My Planned Care - a very useful website which provides information by speciality specifically for the hospital your patient has been referred to.
thepatientsassociation - support for patients whilst waiting for a referral
NHS Digital e-Referral Service - contains useful information on the service, training, and support
NHSE guidance on good communication with patients whilst waiting for care
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