Delivering the 18 Weeks Referral to Treatment Standard Output Report

changes to templates will be made, consistent with the acute services, in terms ofcomplete introduction of 6 weeks clinic cancellation policy across all services.There are some challenges associated with this service. The roll out of the electronicpilot has been slow, partly as a consequence of the unavailability of CHI to thereferrers. This has resulted in health records staff having to input this informationmanually on receipt of referrals. Dental reference files are not routinely updated inthe same way that GMP files are, therefore this also impacts on health records staff.These issues are being addressed.More recent issues raised (as a result of asking GDPs with access to electronicreferrals why they do not consistently use them), are IT issues. Whilst practices werefunded for N3 connection with one PC per practice, the PC tends to be at receptionand additional PCs in surgeries are not always connected to the same network.The project has been supported by IM&T staff who have been the key links withGDS staff.Advice Only ReferralsIt should be acknowledged that secondary care practitioners are under no obligationto see and assess all patients referred. To see all comers for assessment can createa ‘revolving-door syndrome’, confuse patient expectations, undermine the quality ofthe patient experience and can swamp available capacity with a knock on effect onother users of the service.In other specialties, a clinician may refer a patient directly back to General Practicewith advice for further care in a community setting, if the patient is not ready fortreatment or if the referral threshold applied is not appropriate for secondary care.In some instances, referrals into secondary care can be made in order to obtain acare plan, which may then be carried out in primary care. Therefore, there may bescope for further development of an ‘advice-only’ route, which does not necessitatethe patient presenting for assessment in secondary care and ‘using up’ a clinic slotand does not start the 18 Weeks RTT ‘clock.’This practice offers an important feedback loop for professionals and facilitates eachpatient receiving their care in the most appropriate care setting. This has becomestandard practice and can be supported by referral protocols for specific conditions.A number of NHS Boards set this out clearly in their Service Information Directory,and engage in ongoing dialogue with individual practices should they showsignificant variation in their approach to referrals.Action Planning – Advice OnlyConsider developing an ‘advice-only’ route, which does not necessitate the patientpresenting for assessment in secondary care and ‘using up’ a clinic slot and does notstart the 18 Weeks RTT ‘clock.’Dental Specialties Task & Finish Group – January 2011 26