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LLR Clinician to Clinician (C2C) referral policy


We have received reports of practices receiving letters from secondary care requiring patients to be referred to a different specialist or service. In the majority of cases these referrals should be done directly by the hospital.

The agreed local protocol is attached, and the criteria are summarised below. We recommend that if you receive a letter requiring an onward referral covered by the criteria below, that you do not act on it, but contact the responsible consultant and advise them of the C2C policy and request that they do the forward referral (it is OK for a non-clinical member of staff triaging letters to do this). Please also ensure that you complete a ‘Transferring Care Safely’ (TCS) report via PRISM – although a bind to do, without the evidence that this is still happening it is difficult to raise with the Trusts.

Summary of Criteria:

  • Cancer - for investigation, management or treatment of cancer, or suspected cancer. A patient referred internally within UHL with a suspicion of, or confirmed cancer, should be subject to a consultant upgrade as per the trust’s Consultant Upgrade Policy, which facilities the patient being monitored by the cancer centre so that the patient is expedited in line with a similar patient on a 2 week wait referral pathway in primary care.
  • Urgent Referral (between consultants) - where delays in treatment would be detrimental to the patients’ health and require the patient to be seen in less than 2 weeks – this is likely to be rarely appropriate for out-patient referrals.
  • Further investigation or treatment of the clinical condition - cases where further investigation or treatment of the presenting signs and symptoms is considered necessary in order to commence treatment but where these further investigations or treatment(s) could not be conducted by first consultant (e.g., patients with shortness of breath may need to be referred to a cardiologist having been seen by a respiratory physician). Under these circumstances, Clinician to Clinician policy will apply.
  • Multi-disciplinary Teams (e.g., Cancer & Specialised Commissioning MTDs) – cases that require input from more than the clinical specialty to facilitate an holistic approach to fully investigate or treat the presenting signs and symptoms due to the nature of the signs and symptoms. i.e., immunology for certain conditions.
  • Referrals within a speciality for the same condition - cases where it is obvious the referrer has sent the patient to the correct speciality but to the wrong consultant, the referral should be forwarded to the correct clinician without delay. In such circumstances the referral should not be returned to the GP or referrer. The patient’s GP and/or referrer must be promptly informed of this decision and provided with full details of the onward referral. The only exception to this will be where there is insufficient information in the referral to determine this; for instance, this could be where the GP has not used the relevant PRISM form as agreed by primary and secondary care clinical staff.
  • Referrals into the wrong speciality – cases where the first consultant deems the referral has been sent to the wrong speciality or can be more appropriately treated by a different specialty should be forwarded to the more appropriate specialty, without delay, outlining the clinical reason for their decision. In such circumstances the referral should not be returned to the GP or referrer. The patient’s GP and/or referrer must be promptly informed of this decision and provided with full details of the onward referral.
  • Referrals directly related to assessing the patient’s suitability to undergo a general anaesthesia where necessary should be directly referred by the consultant to the anaesthetist or appropriate clinician.
  • For high risk patient groups presenting at A&E who may not readily comply with referral, for example some of those with possible TB. The patients must be directly referred to the outpatient department.
  • A&E referrals to fracture clinic or otherwise defined as urgent in accordance with this policy.
  • If a patient has been seen in an acute assessment area including SDEC, GAU, GPAU and it is felt he/she would benefit from an expert opinion by a speciality in secondary care, then those referrals must be made directly to that team or outpatient clinic.
  • For patients who have been seen by an in-reach speciality (both virtual and F2F) as part of an ED attendance the consulting speciality must facilitate the next clinical step if directly relating to their consult including arranging investigations and clinical review.
  • Suspected adult or child safeguarding concerns.
  • For pre-operative assessment, including assessment in other specialities such as cardiology The clinician initiating a Clinician to Clinician referral needs to ensure that it is documented in the notes why the referral meets the C2C policy.

Please contact the LMC with any queries: enquiries@llrlmc.co.uk
Yours faithfully
Dr Grant Ingrams
Executive Chair

Updated on Friday, 27 October 2023, 214 views

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