Referral methods: e-Referrals

For now, referrals will be made by email.

Please send referrals using the attached referral form to the huh-tr.acersdiagnostichub@nhs.net

Appointments:

Patients will receive their appointments via the post.  If they are unable to attend, they should contact the team on the details below for the appointment to be rescheduled. 

Patients will also receive a text message or phone call confirming their appointment closer to the date and time of the appointment. 

If a patient is unable to attend on the day, they should call the service to alert them to this.

Referral Prioritisation

Due to the significant backlog, a prioritisation stratification in line with the ARTP stratification guidance and agreed by the steering group and Primary Care will focus on patients deemed to the highest priority.  This includes:

Highest Priority patients

• Consider spirometry for those patients with a provisional diagnosis but poor response to treatment (although one hopes further investigation would have already been considered).
• patients for whom diagnostic spirometry will potentially impact their treatment pathway or determine their onward care.
• Those who are symptomatic with cough and breathlessness but no clear diagnosis.
• Those who are symptomatic with cough and breathlessness with diagnosis but no spirometry.

Once the service has reduced the backlog of patients waiting for quality assured spirometry from the highest priority group, the service will concentrate on people from lower priority groups, which includes:

• • Spirometry to confirm diagnosis is valuable but not an immediate priority. If a patient’s history and clinical picture fits with the provisional diagnosis and they respond well to treatment it is important to confirm diagnosis but not at the expense of patients in whom spirometry might alter the diagnosis or treatment (Medium Priority).
  • Reviews of progression of disease but if you still regularly perform spirometry on stable patients (e.g. those with pulmonary fibrosis) these should be at the back of the queue. (Lowest Priority)

The service will not undertake or accept referrals for:

• Annual reviews – this is no longer a requirement for the Quality Outcomes Framework (QOF) and there is little evidence to demonstrate value.
• Case finding on non-symptomatic people.

Respiratory Diagnostic Hubs Process

• During the appointment the hub will complete FeNo testing first and perform spirometry with or without reversibility as per the standard operating policy and as per National guidance.  
• The hub will advise the patient the results will be provided to the referring GP and reassure that spirometry is an aid to diagnosis and is not diagnostic on its own.
• The hub will send diagnostic summary report to practice and discharge patients to GP for appropriate diagnosis and treatment depending on the outcome of testing.
• The hub is not responsible for any initiation of treatment or onward referrals.

To support referral and prioritisation to the Respiratory Diagnostic Hub CEG have outlined possible searches that could be undertaken by each practice if you have not maintained a list of patients awaiting diagnostic spirometry:

CEG have created a suite of searches to help practices prioritise patient recall. Practices will be able to identify 3 cohorts to review and prioritise for spirometry with cohort 1 being patients with highest priority followed by cohort 2 as detailed below.:

• Cohort 1: Patients with a coded exacerbation in the last 12m
• Cohort 2: Patients prescribed Prednisolone in the last 12m
• Cohort 3: Remaining patients with a prescription of LABA/LAMA

Please copy Spirometry Support v1 over to your practice domains. These searches can be found in folder 3. PCN Contracts within the main Practice Support folder.

It is important to note that the aim of the CEG searches is to create a list of patients who may need respiratory diagnostic testing but the list will still need scrutiny to determine if priority for spirometry/FENO, and not send all of the patients through to the service at once.