NHS eReferral Service Enhanced Advice and Guidance NHS

NHS e-Referral Service Enhanced Advice and Guidance

NHS e-Referral Service Enhanced Referral Management (ERM) The upcoming changes to NHS e-Referral Service/Advice and Guidance are part of a programme of new functionality to support NHS England’s drive to ensure the NHS e-Referral Service supports an enhanced Referral Management Process, leading to overall improvements in referral management. The NHS e-Referral Service Roadmap has been published to detail the enhancements to functionality and when they will be delivered.

Please visit the NHS Digital Website to download the NHS e-Referral Service Roadmap www. content. digital. nhs. uk/referrals/future

Enhanced Advice and Guidance Multi-way Conversation • Advice and Guidance multi-way conversation will introduce the ability for clinicians to have multi-way conversations about patients using the NHS e-Referral Service. • The changes include enhancements to the current Advice and Guidance screens and changes to the workflow. These changes will impact all users of the current e-RS Advice and Guidance functionality. This new feature is currently planned for implementation in late March 2017 (subject to final testing).

Enhanced Advice and Guidance Multi-way Conversation Advice Requestor (GP/Referrer) Initiating an Advice and Guidance Request NOTE The following slides are a representation of the new Advice and Guidance – Multi-way conversation screens

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Service Search Criteria No change to searching for an appropriate Advice and Guidance Service Search By: * Request Type * Priority Advice ▼ Urgent ▼ * Enter one or more of the following fields. Entering information in more than one row may reduce the services returned. * Clinical Term � … * Speciality Clinic Type Endocrinology and Metabolic Medicine ▼ Thyroid / Parathyroid ▼ * Named Clinican � … Refine Your Search With Distance within 30 Indicative Wait Time less Than � miles of Postcode ▼ LS 1 6 AD Days Organisation or Site Name … Advice Requestor screens Cancel Additional Requirements View/Modify Shortlist Search Primary Care Search All

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Service Selection No change to searching for an appropriate Advice and Guidance Service ▶ Service Search Criteria Group By: None ▼ ▼ (Results returned: 20) Select Miles Appointment Type Service Name Indicative Appointment Wait Indicative Treatment Wait Directly Bookable Referrer Alert Link to NHS Choices Location ◯ 0 First outpatient Endocrinology Service- Sandwell Hospital SWBH NHS Trust-RXK Limited Availability Yes i i SANDWELL GENERAL HOSPITAL ◯ 4 First outpatient Endocrinology Service-Birmingham Treatment Centre at City Hospital. RXK 60 Days Yes i i BIRMINGHAM TREATMENT CENTRE ◯ 4 First outpatient Thyroid Disorders-Endocrinology. Birmingham Treatment Centre at City Hospital NHS-RXK Limited Availability Yes i i BIRMINGHAM TREATMENT CENTRE ◯ 6 First outpatient Endocrine Clinic- New Cross Hospital-Royal Wolverhampton Trust-RL 4 54 Days Yes i NEW CROSS HOSPITAL ◯ 6 First outpatient Endocrinology Thyroid Disorders Medical Clinic – QEHB – RRK 15 Limited Availability Yes i QUEEN ELIZABETH HOSPITAL BIRMINGHAM ◯ 7 First outpatient Endocrinology – Heartlands Hospital – RR 101 55 Days Yes i HEARTLANDS HOSPITAL ◯ 7 First outpatient Endocrinology – Treatment Centre- Good Hope – RR 106 49 Days Yes i GOOD HOPE HOSPITAL TREATMENT CENTRE ◯ 7 First outpatient Thyroid Disorders – Heartlands Hospital – RR 101 7 Days Yes i HEARTLANDS HOSPITAL ◯ 7 First outpatient Thyroid Service – Treatment Centre – Good Hope – RR 106 35 Days Yes i GOOD HOPE HOSPITAL TREATMENT CENTRE ◯ 12 First outpatient Endocrinology – Samuel Johnson - RJF 61 Days Yes i i SAMUEL JOHNSON COMMUNITY HOSPITAL ◯ 12 First outpatient Endocrinology – Sir Robert Peel – Tamworth - RJF 40 Days Yes i i SIR ROBERT PEEL HOSPITAL i Advice Requestor screens Cancel Search Criteria Appointment Search Request

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Request Details Attachments can be added Advice Status: Not Submitted directly to Advice Request Summary Information Priority Urgent ▼ Named Clinican Dr Smith Add attachment Add web link Enter advice request details here Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Speciality Endocrinology and Metabolic Medicine Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller 2000 characters remaining Send Request Enter Advice Request in the text box Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 New Advice and Guidance Multiway conversation screen Back Update Person

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Request Details Advice Status: Not Submitted Summary Information Priority Urgent ▼ Named Clinican Dr Smith Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Add attachment Add web link Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. Speciality Endocrinology and Metabolic Medicine Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller Test. Results. doc Patients test results X Remove Current. Medication. doc Patients current medication X Remove 1715 characters remaining Send Request Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Select ‘Send Request’ to Submit Advice Requestor screens Back Print ▼ Update Person

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Request Details Advice Status: Provider Response Required Summary Information Priority Advice Requestor has the option to Print or Save as a PDF document by selecting Print Urgent ▼ Named Clinican Dr Smith Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Add attachment Add web link Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. Speciality Endocrinology and Metabolic Medicine Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Attachment 1. doc This doc is related to the referral. Nnnn characters remaining Request Submitted X Remove Attachment 2. doc This doc is related to the patient. X Remove The advice request has been sent to the provider. Nnnn characters remaining Send Request Print ▼ Ok Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Requestor screens Back Print ▼ Update Person

Enhanced Advice and Guidance Multi-way Conversation Advice Responder Service Provider reviewing an Advice and Guidance Request NOTE The following slides are a representation of the new Advice and Guidance – Multi-way conversation screens

Help Alerts (9) e-Referral Service Worklists Worklist Type Directory of Services Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Enquiries Advice and Guidance Requests ▼ Filter Criteria Service Reports Alerts Set as Default Enable Auto Load From the Advice and Guidance Requests Worklist 34 Results Found. Last Refresh 17 -Oct-2016 16: 05. Click ‘Refresh’ to load results. Show All ▼ Clinican Show All ▼ ▶ View Additional Filter Options Clear UBRN 002 8376 5071 0002 8279 0066 0002 8203 9916 002 7907 7775 0002 7879 1527 0002 8203 9916 Priority Status Routine Referrer To Submit Further Information Routine Provider Response Required Routine Referrer To Submit Further Information Advice Last Updated 10 -Oct-2016 21 -Sep-2016 01 -Sep-2016 13 -Jun-2016 06 -Jun-2016 01 -Sep-2016 Advice and Guidance Requests Worklist 0002 7879 1527 Routine Referrer To Submit Further Information 06 -Jun-2016 Advice First Requested Referrer Refresh Selecting UBRN will open the Advice Request Service Name Speciality Endocrinology and Metabolic Medicine Clinic Type Print List Clinican Patient Name Thyroid / parathyroid - SURNAME, Name (Mr) 7 -Oct-2016 ALTAF, Noor Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK 21 -Sep-2016 ESCREET, Marc Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr) 01 -Sep-2016 BARFIELD. Elizabeth Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr) 13 -Jun-2016 COX, Ullrich Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr) 06 -Jun-2016 CLEMENTS, Jane Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr) 01 -Sep-2016 BARFIELD. Elizabeth Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr) 06 -Jun-2016 CLEMENTS, Jane Endocrinology Service -Birmingham Treatment Centre at City Hospital-RXK Endocrinology and Metabolic Medicine Thyroid / parathyroid - SURNAME, Name (Mr)

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Details Summary Information Clincal Information Priority Urgent ▼ Named Clinican Dr Smith Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Advice Conversation 18 -Oct-2016 16: 30 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. Test. Results. doc Patients test results Current. Medication. doc Patients current medication Speciality Endocrinology and Metabolic Medicine Supporting integrated Clinical Information (if sent via GP system) is available Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Responder reviews the Advice Request with any attachments Responder enters the Advice Response in the text box Advice Status: Provider Response Required Responder MUST choose an appropriate response Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she option may have underlying autoimmune thyroid disease Add attachment Add web link Select ‘Submit’ to send Response back Return to referrer with advice I require further information New Advice and Guidance Multiway conversation screen 1766 characters remaining Submit Back Print ▼ Update Person

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Details Summary Information Clincal Information Priority Urgent ▼ Named Clinican Dr Smith Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Speciality Endocrinology and Metabolic Medicine Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Advice Conversation 18 -Oct-2016 16: 30 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. 1. ‘Return to referrer with advice’ This option is for Advice Responders to send a complete Current. Medication. doc Patients current medication response back to the requestor in order for them to take the next appropriate action Test. Results. doc Patients test results Once submitted, the UBRN will DISAPPEAR from the Responders Advice and Guidance worklist Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Responder screens 2. ‘I require further information’ Advice Status: Provider Response Required This option can be used if the Responder requires additional information from the Requestor in order to Add attachment Add web link provide a complete Advice Response. Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease Once submitted, the UBRN will REMAIN on the Responders Advice and Guidance worklist Return to referrer with advice I require further information 1766 characters remaining Submit Back Print ▼ Update Person

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Advice Request Details – 0002 8374 5414 Advice Details Summary Information Clincal Information Priority Urgent Advice Conversation 18 -Oct-2016 16: 30 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Advice Responder has the option to Print or Save as a PDF document by selecting Print Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. Named Clinican Dr Smith Test. Results. doc Patients test results Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Current. Medication. doc Patients current medication 19 -Oct-2016 09: 15 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Speciality Endocrinology and Metabolic Medicine Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease. Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Response Submitted The advice response has been sent to the referrer. Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 ✔ Print ▼ Authorise Conversion To Referral Ok Advice Status: Referrer To Review Response Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Responder screens Cancel Print ▼ Update Person

Enhanced Advice and Guidance Multi-way Conversation Advice Requestor Advice Requester reviewing Advice and Guidance Response NOTE The following slides are a representation of the new Advice and Guidance – Multi-way conversation screens

Help Alerts (9) e-Referral Service Patient Worklist Type Worklists Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Directory of Services Advice and Guidance Responses ▼ Filter Criteria Referrer Enquiries Reports Alerts 3 Results Found. Last Refresh 17 -Oct-2016 16: 05. Click ‘Refresh’ to load results. ALTAF, Noor (Mr) ▼ Set as Default Clear Enable Auto Load Refresh Print List UBRN Patient Name Priority UBRN Created Clinical Context Clinican Response Status Last Action 002 8376 5071 NAME, Surname Routine 17 -Oct-2016 Endocrinology and Metabolic Medicine - Referrer To Review Response 17 -Oct-2016 002 8283 3077 NAME, Surname Routine 11 -Mar-2015 Orthopaedics - Referrer To Submit Further Information 07 -Jul-2016 Selecting the UBRN will immediately open Advice Response Referrer to Review Response Advice Requestor to review the Response given Advice Requestor screens Referrer to Submit Further Information Responder requires additional information to be able to give an appropriate Advice Response

Help Alerts (9) Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. e-Referral Service Advice Request Details – 0002 8374 5414 Advice Request Details Summary Information Clincal Information Priority Test. Results. doc Patients test results Current. Medication. doc Patients current medication 19 -Oct-2016 09: 15 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease. Urgent ▼ Named Clinican Dr Smith Entire conversation is visible, using scroll-bar if required 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK NOTE: Clinical Information has been added / amended Click here to view Speciality Endocrinology and Metabolic Medicine Thanks for that advice - the free T 3 is elevated at 7. 8, but the thyroid antibodies are negative, 30 (normal less than 50). How should the patient be managed ? Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround 20 -Oct-2016 13: 00 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Note the Advice status The elevated free T 3 means this is T 3 thyrotoxicosis, which needs treatment with antithyroid drugs, I would recommend you commence carbimazole 20 mg once-a-day, please warn your patient about the rare but possible side-effect of agranulocytosis. http: //www. imperialendo. co. uk/CBZ. pdf links to a suitable patient information leaflet you can share with them. I would recommend that this patient requires a referral to an Endocrinologist and if the patient choses to come to this trust I would be very happy to see them. Best wishes. Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 If no further action is required, the Advice Requestor can ‘End Conversation’ Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Requestor screens 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Advice Status: Referrer to Review Response Add attachment Add web link Enter advice request details here 2000 characters remaining Send Request Cancel Print ▼ Update Person End Conversation Refer Now

Help Alerts (9) Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. e-Referral Service Test. Results. doc Patients test results Advice Request Details – 0002 8374 5414 Advice Request Details Summary Information Clincal Information Priority Current. Medication. doc Patients current medication 19 -Oct-2016 09: 15 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Pop-up warning is displayed when End Conversation is selected Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease. Urgent ▼ Named Clinican Dr Smith 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK NOTE: Clinical Information has been added / amended Click here to view Speciality Endocrinology and Metabolic Medicine Thanks for that advice - the free T 3 is elevated at 7. 8, but the thyroid antibodies are negative, 30 (normal less than 50). How should the patient be managed ? Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller End Conversation 20 -Oct-2016 13: 00 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) ! This action will terminate the advice request. Only proceed if the advice request is no longer The elevated free T 3 means this is T 3 thyrotoxicosis, which needs treatment with antithyroid required. drugs, I would recommend you commence carbimazole 20 mg once-a-day, please warn your patient about the rare but possible side-effect of agranulocytosis. http: //www. imperialendo. co. uk/CBZ. pdf links to a suitable patient information leaflet you can share You will not be able to reverse this step. with them. I would recommend that this patient requires a referral to an Endocrinologist and if the Do you wish to proceed? patient choses to come to this trust I would be very happy to see them. Best wishes. Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Requestor screens 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) No Add attachment Yes Advice Status: Referrer to Review Response Add web link Enter advice request details here 2000 characters remaining Send Request Cancel Print ▼ Update Person End Conversation Refer Now

Help Alerts (9) Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. e-Referral Service Advice Request Details – 0002 8374 5414 Advice Request Details Test. Results. doc Patients test results Current. Medication. doc Patients current medication Summary Information 19 -Oct-2016 09: 15 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) This can be completed within the Advice and Guidance conversation, rather than having to exit to Refer the patient Clincal Information Priority Urgent ▼ Named Clinican Dr Smith Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease. 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK NOTE: Clinical Information has been added / amended Click here to view Speciality Endocrinology and Metabolic Medicine Thanks for that advice - the free T 3 is elevated at 7. 8, but the thyroid antibodies are negative, 30 (normal less than 50). How should the patient be managed ? Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround Referred By Dr Miller Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Advice Requestor screens 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) 20 -Oct-2016 13: 00 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) The elevated free T 3 means this is T 3 thyrotoxicosis, which needs treatment with antithyroid drugs, I would recommend you commence carbimazole 20 mg once-a-day, please warn your patient about the rare but possible side-effect of agranulocytosis. http: //www. imperialendo. co. uk/CBZ. pdf links to a suitable patient information leaflet you can share with them. I would recommend that this patient requires a referral to an Endocrinologist and if the patient choses to come to this trust I would be very happy to see them. Best wishes. If required, the Advice Requestor can choose to ‘Refer Now’ Add attachment Advice Status: Referrer to Review Response Add web link Enter advice request details here 2000 characters remaining Send Request Cancel Print ▼ Update Person End Conversation Refer Now

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Service Search Criteria Search By: * Request Type Follow steps to refer patient to an appropriate service as per current process * Priority Appointment Urgent ▼ * Enter one or more of the following fields. Entering information in more than one row may reduce the services returned. * Clinical Term � … * Speciality Ensuring that any relevant clinical information is attached to support the Referral Request Clinic Type Endocrinology and Metabolic Medicine ▼ Thyroid / Parathyroid ▼ * Named Clinican � … Refine Your Search With Distance within 30 Indicative Wait Time less Than � miles of Postcode ▼ LS 1 6 AD Days Organisation or Site Name … Referring Clinician screen Cancel Additional Requirements View/Modify Shortlist Search Primary Care Search All

Enhanced Advice and Guidance Multi-way Conversation Service Provider Clinician Reviewing a referral from a converted Advice and Guidance

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Review Referral Summary – 0002 8374 5414 Appointment Details Clinical Information Advice Details Clinical Information UBRN Information Selecting Advice Details from within the Review Referral Summary screen…. . Appointment Date/Time: Priority: Wed 01 -Feb-2017 11: 15 Routine Clinical Context: Thyroid / Parathyroid Location: Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Clinical Term: - Referral Created Date: Clinical Information First Submitted Clinical Information Last Updated: Named Clinician: 18 -Oct-2016 16: 30 Allocated Clinician: Referred By: Referring Organisation: Registered Practice: ALLAN, Susan (Mrs) NAME Outpatient NAME - Patient Information Name: Gender: Date of Birth: Age: NHS Number: SURNAME, Name (Mr) Female 20/01/1931 85 years 999 027 4355 Telephone: Primary Home: 01133974044 Email: Primary Home: Testemail@nhs. net Address: NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 Attachments File Name File Description Added By Date/Time Added Test. Results. doc Patients test results ALLAN, Susan (Mrs) (Referring Clinician) 18 -Oct-2016 16: 30 Service Provider Clinician screens Cancel Change Appointment Date/Time Print ▼ Add Clinical Information Additional Requirements Record Assessment Reject Change Service Accept, Review Next

Help Alerts (9) e-Referral Service Patient: XXXXXXX, Xxxxx (Ms) Gender: Female Date of birth: XX/XX/XXXX Age: XX years NHS: XXX XXXX Review Referral Summary – 0002 8374 5414 Appointment Details Clinical Information Advice Details Summary Information Advice Conversation Priority 18 -Oct-2016 16: 30 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Urgent ▼ Many thanks for your advice - this 72 year old lady is well in herself, however bloods recently showed a suppressed TSH. Looking at her previous results the TSH has been suppressed for some time and the free T 4 is normal at 17 pmol/l. There are no discrete lumps in the neck to feel. Named Clinican Dr Smith Service Name Endocrinology Service. Birmingham Treatment Centre at City Hospital-RXK Test. Results. doc Patients test results Current. Medication. doc Patients current medication 19 -Oct-2016 09: 15 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Speciality Endocrinology and Metabolic Medicine Referrer Alert We offer an advice and guidance service with a 1 -2 business day turnaround In addition to the supporting Clinical Information, the entire Advice and Guidance conversation is available to support the Referral review Suppressed TSH is not uncommon in older people, I would suggest checking the free T 3 level to ensure your patient does not have ’T 3 toxicosis’ and also some thyroid antibodies in case she may have underlying autoimmune thyroid disease. 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Referred By Dr Miller NOTE: Clinical Information has been added / amended Click here to view Referring Organisation NAME Outpatient NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 19 -Oct-2016 08: 05 - Sent by ALLAN, Susan (Mrs) (Referring Clinician) Thanks for that advice - the free T 3 is elevated at 7. 8, but the thyroid antibodies are negative, 30 (normal less than 50). How should the patient be managed ? 20 -Oct-2016 13: 00 - Sent by ALTAF, Noor (Mr) (Service Provider Clinician) Registered Practice NAME STREET TOWN LS 1 4 HY Tel: 0113 496 1234 The elevated free T 3 means this is T 3 thyrotoxicosis, which needs treatment with antithyroid drugs, I would recommend you commence carbimazole 20 mg once-a-day, please warn your patient about the rare but possible side-effect of agranulocytosis. http: //www. imperialendo. co. uk/CBZ. pdf links to a suitable patient information leaflet you can share with them. I would recommend that this patient requires a referral to an Endocrinologist and if the patient choses to come to this trust I would be very happy to see them. Best wishes. Service Provider Clinician screens Cancel Advice Status: Advice Converted Change Appointment Date/Time Print ▼ Add Clinical Information Additional Requirements Record Assessment Reject Change Service Accept, Review Next

Enhanced Advice and Guidance Multi-way Conversation Printing the Advice and Guidance Conversation Note: For both Advice Requestors and Advice Responders

Selecting ‘Print’ opens the Advice and Guidance conversation within PDF Viewer – which can be printed or saved.

Key Points and Considerations INFORMATION FOR CCGs/GENERAL PRACTICE Integrated Clinical Information from GP Systems • Advice and Guidance requests can be initiated from within GP clinical systems. Supporting clinical information can also be sent from integrated GP Systems as well as directly via the e-RS website • For integrated clinical information uploaded to e-RS, e-RS limits the total size of all attachments to 50 Mb. Some GP clinical system suppliers may set individual file-size limit below this Note - For an Advice and Guidance that is converted to a Referral Request, you must ensure all relevant clinical information is attached to support the referral.

Key Points and Considerations Transition to Multi-way conversation What will happen to any Advice and Guidance requests created prior to implementation? 1) For Advice and Guidance Requests created prior to implementation, but not yet responded to • These will be on the Service Provider’s ‘Advice and Guidance Requests’ Worklist with a status of Provider Response Required 2) For Advice and Guidance Responses sent prior to implementation, but not yet actioned by the Requestor • These will be on the Referrer’s ‘Advice and Guidance Responses’ Worklist with a status of Referrer to Review Response In both the above instances, Multi-way conversation can be used following implementation.

Further Information and Contact Us • Further information on the NHS e-Referral Service Enhanced Advice and Guidance can be found on our website, which will be updated regularly http: //content. digital. nhs. uk/referrals/future/electronic • For further information on the benefits of using Advice and Guidance via NHS e-Referral Service, a Case Study is available on the NHS Digital website and can be accessed HERE • If you require additional information or assistance, please contact your local NHS Digital/e-RS Business Change Team member or email us at nhs. ers@nhs. net