Ref Help Susanne Maxwell GP Referrals Advisor Catriona

Ref. Help Susanne Maxwell GP Referrals Advisor Catriona Morton GP Referrals Advisor

Outline � What is Ref. Help, who is in the team and who uses Ref. Help � The process of Ref. Help and Sci-Gateway � Patient journey � Current projects � COVID and Ref. Help � Future of Ref. Help � Final messages and questions

What is Ref. Help?

Specialty guidelines

Individual conditions

Ref. Help Template

Other properties of Ref. Help

Ref. Help Website Access January 1 st – June 30 th 2020 • Average number of page views: 13, 385 per week • Visible dip in views in March due to impact of COVID-19 • New visitors to Ref. Help: 97, 521 • Returning visitors to Ref. Help: 17, 051 • Top three specialties visited during this period: o ENT o Neurology o Gastrointestinal

Where are our users?

Where are our users?

Ref. Help Process OAS, Redesign Team Project Support (Heather Levy) • Various skill set • Support to Ref. Help projects • New page development/ creating pathways • Uploading content • Updating links and resources • Sending update invites • Ref. Helpdesk. Web Team NHS Lothian (EComms)/Web Designers • Provide advice and technical support The GP Referral Advisors Executive/Corporate Sheena Walter Service Manager Outpatient Redesign • Dr Gareth Evans • Dr Catriona Morton • Dr Susanne Maxwell • Dr David Richardson • Dr Robert Manson • Dr Claire Pedder • Kevin Wallace GP reviewers/GP sub group who review Lothian issues escalated from GP Referral Advisors Specialists Clinical leads/ Specialist nurses/AHPs /Service managers • Update content and develop new pathways • Liaise with referrals advisors • Main corporate support • Changes to Ref. Help processes • Review of workplans • Escalation of issues to Senior Management team. Primary Care Contract Organisation • Hire and support line management

Patient Journey � 32 year old female with dizzy spells phones GP � F 2 F assessment shows normal examination � Bloods organised incl FBC, U&Es

Blood results � Hb 101, MCV 65 � Ferritin normal � U&Es normal � On closer questioning no heavy menstrual bleeding, GI blood loss, weight loss etc

Not sure what to do with that abnormal blood result. . .

What to do next. . . Check Ref. Help!

Further results � Iron normal and transferrin <3 � Not an Iron deficiency anaemia � Explain result to patient � ‘Oh I meant to say I spoke with my mum and it turns out she has thalasaemmia trait’ � Refer to Haematology

Patient journey 2 � 76 year old female phones GP new right sided headache � Closer questioning- 5 day history of headache, located around the temple, some associated jaw claudication, no visual symptoms � Urgent ESR- elevated at 100 � Likely diagnosis Giant Cell Arteritis

What to do next. . . Check Ref. Help!

Check Ref. Help! Email address for on-call rheumatology

Check Ref. Help

Current Projects - themes ◦ Single condition multimorbidity ◦ Alternatives to admission / referral ◦ Increased referral acuity ◦ Covid-19! ◦ Collaborative approaches pandemic remobilisation ◦ Realistic medicine – the referral ‘trajectory’ ◦ New non-medical pathways

Current/Recent Projects � Gynaecology cancer- pathway redesign ◦ PMB, Ovarian Cancer, Cervical Abnormalities � MOE ◦ New working group developing guidelines ◦ Delirium, weight loss, falls, dizziness, breathlessness, Parkinson’s Disease ◦ Locality specific pages ◦ HAH pages

Current/Recent Projects � Virtual Sarcoma Clinic (in progress) ◦ New Sci- Gateway template ◦ USOC (2 weeks) vs 6 weeks ◦ Triaged virtually- straight to test, rerouted, appt etc. � New IBS pathway ◦ Dietician led ◦ Talking head videos

IBS pathway Gareth Evans

Talking Heads Gareth Evans

Current/Recent Project cont. Long Covid Pathway � Expected increased demand for post covid investigation/rehabilitation � Cross specialty working ◦ RIDU/ General Medicine/ Neurology/ Allied Health Professionals currently involved � � The pathways will be broadly split into two ◦ 1) Patients needing further investigation. (eg: Diagnostic doubt, Possible 2 nd lung, heart or neurological complications) ◦ 2) Patients purely needing support with rehabilitation (physiotherapy, OH SLT, psychology) The aim is for Refhelp to have a general ”signposting” Long Covid condition page with links to the relevant specialty pages Dave Richardson

Current/Recent Projects �Palliative Care ◦ New guidelines for Covid 19 �Mental Health ◦ New CCBT programmes

Recent projects…

Self-referral: psychoeducation

‘Deep Dive’ Referrals Advisors �Ophthalmology – Kevin Wallace �Dermatology- Clare Pedder �Urology- Robert Manson �ENT- Catriona Morton

‘Deep Dive’ Dermatology- Clare Pedder �Updated Ref. Help guidelines ◦ Primary care management ◦ Image examples �Dermatology updates educational

‘Deep Dive’ Dermatology

‘Deep Dive’ Urology- Robert Manson � Updated Ref. Help guidelines on urological conditions � Recent audit of 100 randomly selected GP referrals ◦ What proportion were not covered by Ref. Help? ◦ Quality of referrals � Aim to increase advice referrals