Mid Nottinghamshire GP Peer to Peer Referral Review Tools

Introduction

NHS England have directed that all practices are to prospectively peer review all routine referrals to secondary care by September 2017. GP Peer review of referrals has been linked with lower clinical variation amongst referrers. GPs are broadly experienced and motivated clinicians with a commitment to reflective practice. It is recognised that GPs across Mid Notts have many informal and formal routes for getting peer review in their clinical setting building on the P2P Better Together guidance.

The Ardens System One Referral Review Template makes it possible for GPs to perform peer review remotely before a referral is sent and digitally record outcomes for audit and reflection.

Ardens Referral Review Template

This template is live on SystmOne and accessible to all GPs. Using the following protocol GPs can peer review colleagues quickly and remotely discussing cases in person if needed.

The Referring GP retains the final decision on what action is to be taken.

An example protocol for using the template in practices is below and will need small adaptions for different working habits. The referring GP and Secretary roles vary across practices.

Example Protocol

Step 1: Referring GP writes / dictates referral and sends task to Secretary

Step 2: Secretary creates referral and sends task to Peer Reviewing GP (this can be any suitable GP as decided by each practice) using the orange Ardens

communications arrow as follows:

Step 3: Peer Reviewing GP receives task and opens Referral Review Template, reads Referral letter, ticks “Referral Review Done” and returns task to Referring GP with comments.

Step 4: Referring GP opens Referral review template (as previous), reads comments from Reviewing GP, ticks “Referral Needed” or “Referral Cancelled” and tasks Secretary. Initiates alternate management plan as needed.

Potential Peer Review Topics

Peer reviewing GPs will usually consider these topics and others they feel are appropriate. A lot of information will be contained in the auto-populated referral letters and so will not be covered in the narrative section of the referral letter. Some suggested topics are given below, this list is not mandatory or exhaustive:

Is there any variation between what the referrer has done and peer reviewer would do in this case?

Has primary care National and Local clinical guidance been followed?

(Ardens Referral Criteria tool based on NICE)

(CKS website) (CCG Pathways website)

Is primary care treatment and investigation complete?

Is there evidence of Shared Decision making?

Is there a community service that is appropriate?

Does the letter contain enough information?

Reason for referral History and Examination Previous Management Investigations Past Medical History Drug History and Allergies

Audit

Referral reviews and outcomes are audited by using ready-made Ardens SystmOne Reports.

They are reached by going to Clinical Reporting > Ardens > Contracts > Referral Review : DNA / Done / Needed / Cancelled / Rejected

Further instructions can be found on the Ardens support website: https://support.ardens.org.uk/support/solutions/articles/31000126940-referral-review

Informal and formal referral review meetings can use this tool and reporting to support and encourage discussion and reflection on differences in practice.