Implementation of policies affecting patient referral

Once a clinical policy is approved by the relevant executive committees of each of the CCGs there is a clear communication plan to disseminate this throughout the health community in Devon.  Because some policies relate only to referral, some relate only to secondary care decision making and some relate to both referral criteria and secondary care provider decision making there is a need for clarity on how the policy should be applied in each of these settings once published.

Even though referrers and provider specialists will have been given prior notification of the policy implementation date, when a policy is published there will inevitably be patients who have been referred by their GP and are awaiting their outpatient appointment, either having been given an appointment date or waiting to receive an appointment.

Since these patients’ clinical circumstances are not different from those who present to the health service from the date of publication of the policy and for whom decisions will be made in accordance with the policy, it would be iniquitous to proceed with the referral and/or treatment unless the patient met the policy criteria. However, it is only possible for the referral centre to intervene on referrals which have not yet been passed to secondary care.

The policy should therefore be applied in accordance with the following:
  • For policies that relate to patient treatment decisions made in the setting of secondary care providers, the providers are expected to apply the requirements of the policy to any patient who is seen from (and including) the date of policy publication stated.  Planned surgery may go ahead for for patients who have already been told by the secondary care consultant that they will be receiving a date for surgery.
  • For policies that specify criteria that need to be met for a referral, the referral management centre will apply these criteria to referrals that are received from (and including) the date stated on the policy.

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