Using PCIT SystmOne Letter Template - Norfolk & Waveney

Using PCIT SystmOne Letter Template - Norfolk & Waveney

Introduction 

The PCIT Letter template provides a single, central location for accessing referral letters and and forms across Norfolk & Waveney and West Suffolk.   

The template contains a comprehensive set of documents designed to support administrative staff and clinician in managing referrals and communication efficiently.  These documents are organised by clinical specialty and function, making it easy to locate the appropriate referral forms 

All referral forms are: 
  1. Maintained and updated in line with the Integrated Care Board (ICB) Norfolk & Waveney requirements
  2. Linked directly to the buttons within each section of the template
  3. Standardised to support consistent and accurate referrals 
Within the Letter Template, you will find a wide range of resources including referral forms, consent forms, Patient Specific Direction forms, administrative letter templates etc.  These are sourced and maintained in line with local pathways across Norfolk & Waveney, ensuring consistency and compliance with current guidance.  

This article provides an overview of the types of documents available within the Letter Template and how they are structured, helping you quickly identify and use the most appropriate resource for your workflow. 
Use this support article is design to search for the referral forms and quickly locate the correct category if unsure.  

Alert
If your practice has created its own localised or custom templates, these should not be accessed or recreated using this template.  Instead, these letters should be created via the ‘Letter & Communications’ node within the patient record.
Alert
We do rely on local intelligence regarding all the West Suffolk referral forms. If you have a more current version, please raise a support ticket so we can update these for you.

What does it actually do?

This template acts as a navigation hub for referral forms. 

How it works: 

  1. Open a patient record
  2. Launch the PCIT Letter Template   from the side toolbar on a template
  3. Select the relevant clinical category (e.g. cardiology, Female,  Gastro, Suspected Cancer)
  4. Choose the required referral form 
  5. Complete and Save the letter into the patient record
Each button links directly to a specific referral form, removing the need to manually search for documents

What does it look like?

  
  

Last Updated 

19th March 2026

Letter Categories

  1. Suspected Cancer 
  2. Administrative & Dragon 
  3. Asthma and COPD 
  4. Cardiology 
  5. Community Services – A to M 
  6. Community Services – N to Z 
  7. CQC Alerts 
  8. Diabetes 
  9. Domestic Abuse 
  10. Derma & ENT & Ophthalmology 
  11. Female 
  12. Funding request – A to M 
  13. Funding request – N to Z
  14. Gastro 
  15. Geriatric 
  16. Health Promotion and Social 
  17. Mental Health 
  18. MHRA Alerts 
  19. Musculoskeletal 
  20. Neurological 
  21. Paeds 
  22. Palliative Care 
  23. PDSs 
  24. Radiology 
  25. Specialist Services

List of all Referral Forms 

Use Ctrl + F to search for the referral form name

Categories 

Document Title 

Suspected Cancer 

·         Urgent Suspected Cancer Brain & CNS 

·         Urgent Suspected Cancer  Breast 

·         Urgent Suspected Cancer Children’s 

·         Urgent Suspected Cancer Gastro 

·         Urgent Suspected Cancer  Gynae cancer 

·         Urgent Suspected Cancer Haematology 

·         Urgent Suspected Cancer Head & Neck 

·         Urgent Suspected Cancer HPB 

·         Urgent Suspected Cancer Lower GI 

·         Urgent Suspected Cancer Lung 

·         Urgent Suspected Cancer Prostate 

·         Urgent Suspected Cancer Sarcoma 

·         Urgent Suspected Cancer Skin 

·         Urgent Suspected Cancer Urology 

Administrative & Dragon 

Administrative & Dragon (Main Forms)

·         Coroner Pre-Referral Form Norfolk 

·         Dragon Referral Template fixed 

·         GP Notification of Death Review – West Suffolk 

·         Integrated Care Coordinator ICC – South Locality 

·         ME-1A Medical Examiner Form 

·         Medical certificate – Cremation Form 4 

·         Serious incident reporting Form 

·         Medication For Patients Having MRI scans 

·         Police requests Pro Forma For GP Practices 

·         PID Contractual Breach LMC N&W 

·         Report a notifiable disease paper form 

 

HbA1c Letters

·         HbA1c result not accurate – blood test inaccurate 

·         HbA1c test – result not accurate – needs review appt 

·         HbA1c test result not accurate – needs blood test 

·         HbA1c – correct pre-diabetes diagnosis 

·         HbA1c – possible pre-diabetes 

·         HbA1c not accurate – incorrect pre-diabetes diagnosis 

·         Recent HbA1c – Type 2 Diabetes confirmed 

 

Consent Forms 

·         Consent form – Hormonal Coil Insertion 

·         Consent Form – Hormonal Coil Replacement 

·         Consent form – Non-Hormonal Coil Insertion 

·         Consent Form – Non-Hormonal Coil Replacement 

·         Consent Form – Implant Contraceptive Insertion 

·         Consent Form – Implant Contraceptive Removal 

·         Consent Form – Implant Contraceptive Replacement 

·         Consent form – Minor surgery 

 

Home BP Monitoring

·         Home Blood Pressure Reading Form 

Asthma & COPD

Action Plans 

·         Asthma Action Plan 

·         PRINT Asthma Action Plan 

·         Child Asthma Action Plan 

·         PRINT Child asthma action plan 

·         COPD self-management and action plan 

·         PRINT COPD self-management and action plan 

Referrals & Assessments 

·         Community COPD Referral – QEH 

·         Obstructive Sleep Apnoea Checklist – NNUH 

·         Post COVID-19 Syndrome MDT Assessment 

·         Pulmonary Rehabilitation – NCHC 

Cardiology 

Referrals & Services 

·         Heart Failure Referral – Norfolk & Waveney 

·         Heart Failure Echocardiogram – QEH – N&W 

·         Lipid Referral Form – WSH 

·         Heart failure nurses referral – WSH 

·         Syncope Clinic 

·         Rapid chest Pain Clinic – NNUH NW 

·         Rapid Access Chest Pain Clinic – JPUH 

·         Rapid Access Chest Pain – QEH 

·         Palpitation Symptoms Patient Questionnaire

Community Services (A to M) 

Community Services (A–M) 

·         Adult Phlebotomy – JPUH 

  ·         Adult Community Therapy Service - NCHC 

·         Alzheimers.org referral (admiral nurses) 

·         Aural Microsuction Combined Referral - N&W 

·         Avocet Clinic Form 

·         Change Grow Live Referral 

·         Circumcision - NWCB

·         CYP Community Children's Service - NCHC NW

·         Community COPD Referral - QEH

·         Community Matron

·         Community Nursing therapy Assessment Request

·         Dietetic Adult NCHC 

·         Eyellid Ptosis - NWCB

·         Epilepsy Specialist Nurse Adult - NCHC 

·         Epilepsy Specialist Nurse Adult - NCHC 

·         Foot Health 

·         General Surgical Referral – Southgates 

·         Heart Failure South Norfolk Referral Form 

·         Lymphoedema – JPUH 

·         Lymphoedema – Central Norfolk/WSH – NCHC 

·         ME / CFS ECCH 

·         Medicines Support service (NMSS) 

Community Services (N to Z) 

Community Services (N–Z) 

·         Non-dental Referrers 

·         Norfolk Community Therapy Services 

·         Norfolk & Waveney Special Care Dental Service 

·         Outpatient Parenteral Antibiotic Therapy – QEH 

·         Outpatient parenteral antibiotic therapy NCHC QEH 

·         Oxygen Assessment – NNUH 

·         Paediatric Phlebotomy – JPUH 

·         Post COVID-19 MDT Assessment Adult 

·         Post COVID-19 MDT Assessment – child 

·         Rhinosinusitis & Rhinitis Referral Aged 12+ 

·         SALT Adult – ECCH 

·         SALT Adult West Norfolk – NCHC 

·         SALT Adult – NCHC 

·         Scars and Keloids Referral 

·         Syringe Driver EOL Chart – JIC 

·         Syringe Driver EOL Chart – JIC + Syringe Driver 

·         TVN referral form 

·         Vida skin lesion clinic NW 

·         Vasectomy – Community Referral – WSH 

·         Wheelchair Assessment – NCHC

CQC Alerts

·         CQC – Hydrochlorothiazide risk letter 

·         CQC – Teratogenic drug risk letter 

·         CQC – SGLT2 Risk letter – Generic 

·         CQC – SGLT2 Risk letter – CKD 

·         CQC – SGLT2 Risk letter – Diabetes 

·         CQC – SGLT2 Risk letter – Heart Failure 

Diabetes

Services & Referrals

·         Acute Diabetic Foot Clinic – NNUH 

·         Diabetes Elsie Bertram Centre – NNUH 

·         Diabetes Nurse Facilitator – NNUH 

·         Diabetes Type 2 Structured Education DFAC – NNUH 

·         Diabetic Retinal Screening – JPUH 

·         NDPP – Heather ‘You Diabetes Prevention’ 

·         NDPP – Patient Invite Letter – Norfolk 

·         T2DR Programme NW 

·         Type 2 Diabetes Patient Leaflet 

·         GDM NDPP GP letter to patient 

Domestic Abuse

 

·         Freedom Referral Form 

·         MARAC Check list 

·         MARAC DASH – Norfolk 

·         MARAC Referral Form – Norfolk 

·         NIDAS link for referrals – medium risk 

·         NIDAS Resource link 

Dermatology, ENT & Ophthalmology 

·         Aural Care Clinic – NNUH 

·         Aural Microsuction Combined Referral – N&W 

·         Chalazion – NMCB 

·         Dermatology Form – WSFT 

·         Epiphora – NMCB 

·         ENT PRG – Ears – WSH 

·         ENT PRG – Rhinology (all) – WSH 

·         ENT PRG – Throat – WSH 

·         Hearing Aid Direct Access – JPUH 

·         Hearing Aid – Central Norfolk 

·         Suspect Wet AMD Rapid Access Referral 

·         Tinnitus – NNUH 

·         Tinnitus Direct Access – JPUH 

·         Tinnitus Checklist Final 

·         Tonsillectomy Adult – NMCB 

·         Tonsillectomy Child – NMCB 

·         Tonsillectomy CCT – NMCB 

·         Tonsillectomy OSA Adult – NMCB 

·         Tonsillectomy OSA Child – NMCB 

Female

·         Assisted Conception – Fertility Services Level 2 

·         Fertility Preservation – Bourn Hall 

·         Fertility Services – Data Sharing Consent Form 

·         Breast Clinic Family History – NNUH 

·         Breast Cancer Family History – QEH 

·         Maternity Booking – NNUH 

·         Early Pregnancy Assessment Unit (EPAU) – JPUH 

·         Early Pregnancy Assessment Unit (EPAU) – WSH 

·         Termination of Pregnancy – BPAS – NMCB 

·         Termination of Pregnancy – JPUH 

·         Cosmetic Breast Surgery – NMCB 

·         Coil Service Magdalen Medical Norwich 

·         Female Genital Prolapse – NMCB 

·         Female Sterilisation – NMCB 

·         Perinatal Mental Health – NSFT 

·         Risk Awareness Form – Epilepsy 

·         Risk Awareness Form – Prophylaxis of migraine 

·         Valproate Annual Review – NMCB 

·         Valproate Sexual Health Service – NMCB 

Funding Request (A to M)

·         Aesthetic Cosmetic Breast Surgery – NMCB 

·         Blepharoplasty – NMCB 

·         Benign Skin Lesion – NMCB 

·         Carpal Tunnel Syndrome – NMCB 

·         Cataract – NMCB 

·         Chalazion – NMCB 

·         Circumcision – NMCB 

·         Cosmetic Excision of Head and Neck Skin – NMCB 

·         D&C Hysteroscopy 

·         Dupuytren’s – NMCB 

·         Epiphora – NMCB 

·         Eyelid Ptosis – NMCB 

·         Eyelid Ectropion – NMCB 

·         Facet Joint Injections – NMCB 

·         Female Genital Prolapse – NMCB 

·         Ganglion Surgery – NMCB 

·         Grommets Children – NMCB 

·         Grommets Adults – NMCB 

·         Hallux Valgus – NMCB 

·         Hernia – NMCB 

·         Hip Arthroscopy – NMCB 

·         Hips & Knees Arthroplasty (Osteo-arthritis) – NMCB 

·         Hysterectomy for HMB – NMCB 

·         IFR – Drug Requests 

·         Individual Funding Request – Non-Drugs N&W 

·         Knee Arthroscopy not OA related – NMCB 

·         Lipoma – NMCB 

·         MSK Foot & Ankle – NNUH 

·         Mortons Neuroma – NMCB 

Funding Request (N to Z)

·         Pinnaplasty - NMCB

·         Plantar Fascitis - NMCB

·         Podiatry surgery funding request 

·         Rhinoplasty/Septoplasty funding request 

·         Rhinosinusitis & Rhinitis Referral Aged 12+ 

·         Scars and keloids – NMCB 

·         Spinal Fusion – NMCB 

·         Surgical Discectomy – NMCB 

·         T08 Male Circumcision – WSH 

·         T12 Vasectomies – WSH 

·         T18a – Hip Replacement Checklist – WSH 

·         T18B – Checklist Knee Replacement – WSH 

·         T24 – Botox – WSH 

·         T26 Female Sterilisation – WSH 

·         T32 – Hernias – WSH 

·         T06 Varicose Veins – WSH 

·         T9a Carpal Tunnel Syndrome Surgery – WSH 

·         Tonsillectomy Adult – NMCB 

·         Tonsillectomy Child – NMCB 

·         Trigger Finger – NMCB 

·         Varicose – NMCB 

·         Vasectomy – NMCB 

Gastro 

Endoscopy & Procedures

·         Endoscopy Upper GI Urgent – NNUH 

·         Endoscopy Upper GI Routine – NNUH 

·         Upper GI Endoscopy – JPUH 

·         Endoscopy Upper GI Urgent – QEH 

·         Upper GI Endoscopy Routine – WSH 

·         Endoscopy on Antiplatelets – QEH 

 

Clinics & Referrals

·         Dietetic Adults – NCHC 

·         IBD Clinic Urgent – NNUH 

·         IBD Clinic Urgent – QEH 

·         Haemorrhoids – NMCB 

·         Iron Deficiency Anaemia – NNUH 

Geriatric 

·         OPAS – NNUH 

·         OPAS Patient Leaflet – NNUH 

·         Dementia care plan 

·         PRINT Dementia care plan 

Health Promotion and Social 

·         Active NoW – Physical Activity & Exercise Service 

·         Behavioural Support Obesity – BSOP – NW 

·         Fit4It (children) 

·         Inappropriate transfer of work (weight loss) 

·         NDPP – Healthier You Diabetes Prevention 

·         Oviva T3 Referral Form NW 

·         Tier 2 Weight Management CYP 4–18yrs 

·         Digital Weight Management 

·         SmokeFree Cessation – ECCH 

·         Smokefree Norfolk Reed Wellbeing N&W 

·         Social Prescribing Referral Form 

·         Voluntary Norfolk – Health & Wellbeing Service 

·         Unexplained weight loss referral – WSH 

Mental Health 

·         Adult ADHD Framework – NMCB 

·         Adult ADHD (Age 18+) – NSFT 

·         Adult Autism Service Norfolk (exc Waveney) 

·         AQ-10 

·         CYP Neuro Development RTC 

·         Memory Assessment Service (MATS) – NSFT 

·         Mental Health 0–25 years – N&W 

·         Mental Health Cafe KL 

·         Mental Health and Housing Needs Referral – NHCSS 

·         Mental Health referral NSFT CN WN 

  ·         PHQ-9 and GAD-7 Form 

·         CATS Parent Questionnaire 

·         CATS Referral Form RTC

MHRA Alerts

·         MHRA002-a) b) or c) Emerade 

·         MHRA004-a) Picato gel 

·         MHRA005-a) Finasteride 

·         MHRA006-b) Esmya 

·         MHRA007-a) or b) steroid treatment card 

·         MHRA010 Heart Valve & DOAC Letter to Cardiologist 

·         MHRA010 Heart Valve and DOAC Letter to Patient 

·         MHRA011-a) Simvastatin and calcium channel blocker 

Musculoskeletal

·         Early Inflammatory Arthritis – NNUH 

·         Foot Health 

·         Hips conservative pathway NNCCG 

·         Hips & Knees Arthroplasty – NMCB 

·         ME – CFS – ECCH – N&W 

·         MSK Foot & Ankle – NNUH 

·         MSK Shoulder – NNUH 

·         MSK SpOA – N&W 

·         MSK SpOA – WSH 

·         Pain Management – QEH 

·         Pain Management – JPUH 

·         Pain Management – WSH 

·         Podiatry / Chiropody SPA – Suffolk GP Federation 

·         US Injection patient information and consent 

Paeds

·         Acne All Acutes Referral 

·         Adolescent Eating Disorder – NSFT 

·         Community School Nursing – Suffolk Council 

·         CYP Community Children’s Service – NCHC NW 

·         CYP Healthy Child Programmes 5–19y 

·         CYP CC Consent Form 2022 NMCB 

·         CYP Conti Care Referral Form and Checklist 2024 

·         DNAR Child Form 

·         Emotional Wellbeing Child – Point 1 

·         Family Action WellFamily – Swaffham 

·         Fit4It (Children) 

·         GIDS Referral Processing – Risk Assessment 

·         Joint Protocol School Absence Health Professional 

·         Mental Health 0–25 years – N&W 

·         Orthotics Paediatrics – QEH 

·         Paediatric Feeding Clinic – JPUH 

·         Paediatric Allergy Clinic – NNUH 

·         Paediatric Hearing Assessment – NNUH 

·         Paediatric Hearing Test – JPUH 

·         Paediatric Phlebotomy – JPUH 

·         Pinnaplasty – NMCB 

·         SALT Paediatric – CCS 

·         School Nursing Team Young Persons Self-Referral 

·         School Readiness Health Check 

·         Tongue Tie/Restrictive Lingual Frenulum – NNUH 

·         Tier 2 Weight Management CYP 4–18yrs

Palliative Care 

·         CHC Fast Track Pathway Tool inc Consent Form 

·         CHC Consent Template June 2023 

·         CHC – Consent with/without consent 

·         DNSCPR Form 

·         Norfolk Hospice Tapping House Referral – NHTH 

·         RESPECT Form 

·         Specialist Palliative Care – NCHC 

·         Syringe Driver EOL Chart – JIC + Syringe Driver 

·         Syringe Driver EOL Chart – JIC 

Patient Specific Directions (PSDs)

·         Blank PSD

·         B12 PSD 

·         Inhaled Salbutamol PSD 

·         Pneumococcal PSD 

·         Shingles PSD 

·         Influenza (Pregnant) PSD 

·         Influenza NOT pregnant PSD 

Radiology 

·         MRI direct access 

·         Direct Access Ultrasound form 

·         Direct Access MRI Head only – QEH 

·         Radiology – QEH 

·         Radiology ICE Downtime Request – NNUH 

·         Radiology Speciality – JPUH 

·         Radiology X-ray – JPUH 

·         Spire Norwich Hospital – Imaging Request Form 

·         X-ray Request – NNUH 

·         Cora Norwich Clinic Private Referral Form 

Specialist Services

·         Adolescent Eating Disorders – NSFT 

·         Adults with learning disabilities referral – HPFT NW 

·         CEW Clinic Referral Proforma_EoE 

·         Eating Disorders – Adult (NCEDS) 

·         Eating Matters – Norfolk & Waveney 

·         Gender Identity Adult Referral Form 

·         Neurofibromatosis Referral Form - Guy's & St Thomas Hosp

·         Norfolk Community Eating Disorder Service (NCEDS) 

·         Rare Disease Genomic Test Form 

·         Leg ulcer direct referral – Nurses (NNUH) 

·         Unexplained weight loss referral – WSH 


How to get it

 The PCIT Letter - Norfolk & Waveney Template is accessible via the side toolbar which is available across all PCIT template.
  1. This is a single, consistent location
  2. The toolbar is available across all PCIT templates
  3. Selecting the Letter icon    will launch the template within the patient record 
Once selected, the Letter template will open, allowing you to navigate to the relevant specialty and referral form.  

System Dependencies:

Access to the PCIT Letter Template - Norfolk & Waveney is limited based on the commissioning subscription. 
  1. This template is only available to practices within Norfolk & Waveney (and application pars of Suffolk)
  2. Practices must be signed up to the PCIT Referral Tree package to access this resource. 
If the template is not visible, this is likely due to the practice not being part of the commissioned service or package. 

Fitting your practice

This template is designed to support everyday administrative and clinical workflow by: 
  1. Providing a standardised approach to referral 
  2. Ensuring forms are up-to-date and ICB-aligned 
  3. Supporting both clinical and non clinical staff 
Practices can incorporate this into their workflow by using the template as the default starting point for all referrals.  to maximise its use within your practice: 
  1. Ensure secretarial and administrative staff are aware of the PCIT Letter template
  2. Share this support article so staff understand how to locate and use referral forms 
  3. Encourage use of the template as a default starting point for all referrals




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