Category: General Practice Referrals

General Practice referral guidelines

Carotid Artery Disease

Scott McLaughlin

General Guidelines

Priority will be given to patients with critical limb ischaemia (rest pain, arterial ulcers, necrosis), symptomatic carotid stenosis and aortic aneurysm – who are likely to require surgical or radiological intervention.

Carotid Artery Disease

Patients with suspected carotid artery disease should be referred urgently if they present with symptoms of stroke, TIA, or amaurosis fugax.
Varicose Veins
NHS Lanarkshire does not offer treatment for thread veins or reticular veins or any cosmetic treatment for varicose veins.

Referral Criteria For Varicose Veins

  • Open or healed varicose ulcer
  • Active varicose eczema (unresponsive to topical steroids and compression)
  • Recurrent superficial thrombophlebitis requiring NSAID therapy and compression
    • (* Phlebitis/thrombophlebitis is defined as acute onset, tender, hard, lumpy veins due to thrombosis. It is Not just painful veins. Standard treatment is NSAIDs and compression, not antibiotics. Patients should not be referred on first episode unless there is clinical evidence of thrombosis extending up to the groin)
  • A history of venous haemorrhage where there is a likelihood of further bleeding

Leg Ischaemia

Most patients with recent onset intermittent claudication will improve spontaneously – especially if they are encouraged to correct known risk factors. Furthermore timely attention to secondary prevention will reduce mortality and morbidity due to cardiac and cerebro-vascular disease in this high-risk group. Patients with mild to moderate intermittent claudication do not require invasive vascular interventions. If you have access to ABPI measurements, then that may help confirm the diagnosis.

Patients with severe intermittent claudication, not improved by a regime of smoking cessation, walking exercise, antiplatelet treatment, statin, weight reduction (as required) should be referred for vascular OP Clinic assessment.

Aortic Aneurysm

Patients with suspected aortic aneurysm, even without related symptoms, should be referred as an urgent case to the Vascular OP Clinic.
Patients with suspected symptomatic abdominal aortic aneurysm (i.e. recent onset or increasing back pain, acute tenderness of the aneurysm, distal embolism) should be referred as an emergency to the Receiving Surgical Team.

 

Beating the Blues (Mental Health) Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main Presenting Complaint: [Beating the Blues Referral]

Has this been discussed with the patient:

  • Yes
  • No

If not discussed, please give explanation. (See Guidelines for contact details): [Text]

Date of Onset: [Date]

Priority: [Routine]

Is the patient currently taking anti-depressants:

  • Yes
  • No

Please indicate the persons education level:

  • Primary
  • Secondary
  • Higher and/or University
  • Other

Preferred method of communication:

  • Email
  • Phone or Text
  • Letter

Please provide details if not complete:

Mobile phone number: [Text]

Email Address: [Text]

Beating the Blues Guideline

Audiology Paediatric

Scott McLaughlin

General Information

Patients referred to this service will be seen by Specialist Paediatric Audiologists but may not be seen by medical staff within the Audiology Department. The Clinical responsibility for patient?s treatment will remain with the General Practitioner, unless there is onward referral to an Associate Specialist in Audiology or to an ENT Consultant for further management.

Referral Guidelines

Patients must meet the following criteria before the Audiology department will accept the referral.

Please see vetting guidelines.

The following patients are suitable for direct referral to ENT:

 

Child referred with concern re hearing: From 8 months to 4 years

Paediatric ENT Clinics

Any child with referral mentioning significant snoring, nasal obstruction, obstructive sleep apnoea, frequent ear infections or tonsillitis should be redirected for ENT appointment.

 

Child referred with concern re hearing: From 4 to 6 years

Paediatric ENT Clinics

Referral directed to ENT if history of significant snoring, nasal obstruction, obstructive sleep apnoea, catarrhal, frequent ear infections or tonsillitis.

Referral where there is history of recent ENT surgery within past year with recurrence of symptoms or related complaints.

 

Children referred re hearing concern: From 6 to 18 years

ENT Clinics

Those whose referral indicates significant history relating to OME, tonsillitis, snoring or obstructive sleep apnoea as previously.

Referral where there is history of recent ENT surgery within past year with recurrence of symptoms or related complaints.

Audiology Hearing Aid Referral

Scott McLaughlin

General Information

Patients referred to this service will not be seen by medical staff within the Audiology Department. The Clinical responsibility for patients treatment will remain with the General Practitioner.

The Audiology Department can offer travel to Hairmyres Hospital, Stonehouse Hospital, MDGH or Wishaw General Hospital if required –please indicate that transport is required

Housebound/Nursing home patients who are unfit to travel can be seen on a domiciliary visit. (Use separate template)

Referral Guidelines

Patients must meet the following criteria before the Audiology department will accept the referral:

  • Patient must be over 50 (under 50 if learning disabilities)
  • Hearing loss is not of short duration
  • Hearing loss is not of sudden onset
  • Hearing loss is not asymmetric or unilateral There is no rotary vertigo
  • There is no severe tinnitus
  • There is no external or middle ear infection There are no perforations
  • There is no recent discharge
  • Both ears are free from wax at time of referral

Please note: Wax Removal may be arranged by the department if necessary

Hearing Aid Repairs

Please advise patients that there is a walk in service available for hearing aid repairs and battery replacements, as follows:

Audiology Services,
Douglas St Clinic,
Hamilton, ML3 0BP.
Tel: 01698 368700
Tuesday – Friday, 1.30 – 4 pm
Central Advice Line
01698-456556

 

Hairmyres Hospital,
Eaglesham Road,
East Kilbride,
Tel: 01355 585000.
Mon, Tues, Wed 9.30 – 11.30
Tues 2.00pm – 4pm

 

Stonehouse Hospital,
Stonehouse,
Tel: 01698 794015
Tuesday 1:30 – 4pm
Thurs only 9.30am – 11.30am

 

Audiology Clinic,
Wishaw General,
Wishaw.
Tel: 01698 361100
Mon, Tues, Wed, Frid,
9.30am – 11 30am

 

Audiology Clinic OPD,
Monklands Hospital,
Airdrie, ML6 0JS
Tel: 01236-712028
Mon – Thursday
1.30-4pm

 

Lanark Health Centre,
Lanark.
Tel: 0155661534
2nd and 4th Friday
9.30am – 11.30am

 

Central Health Centre
North Carbrain Road,
Cumbernauld, G67 1BJ
Tel: 01236 731771
Mon only 9.30am – 11.30am

Audiology Domiciliary

Scott McLaughlin

General Information

Patients referred to this service will not be seen by medical staff within the Audiology Department. The Clinical responsibility for the patients treatment will remain with the General Practitioner

NB: The Audiology Department can arrange travel to Hairmyres Hospital, Stonehouse Hospital, MDGH and Wishaw General Hospital if this would be a suitable alternative.

Referral Guidelines

Patients must meet the following criteria before the Audiology department will accept the referral:

  • Patient must be over 50 (under 50 if learning disabilities)
  • Hearing loss is not of short duration
  • Hearing loss is not of sudden onset
  • Hearing loss is not asymmetric or unilateral
  • There is no rotary vertigo
  • There is no severe tinnitus
  • There is no external or middle ear infection
  • There are no perforations
  • There is no recent discharge
  • Both ears are free from wax at time of referral

 

OR

If the patient is an existing hearing aid user that requires to have a new hearing assessment.

NB: Patients that require a hearing aid repair may contact directly to arrange a Domiciliary visit.

Please note: Wax Removal may be arranged by the department if necessary

Aortic Aneurysm

Scott McLaughlin

General Guidelines

Priority will be given to patients with critical limb ischaemia (rest pain, arterial ulcers, necrosis), symptomatic carotid stenosis and aortic aneurysm – who are likely to require surgical or radiological intervention.

Aortic Aneurysm

Patients with suspected aortic aneurysm, even without related symptoms, should be referred as an urgent case to the Vascular OP Clinic.
Patients with suspected symptomatic abdominal aortic aneurysm (i.e. recent onset or increasing back pain, acute tenderness of the aneurysm, distal embolism) should be referred as an emergency to the Receiving Surgical Team.

Varicose Veins

NHS Lanarkshire does not offer treatment for thread veins or reticular veins or any cosmetic treatment for varicose veins.

Referral Criteria For Varicose Veins

(MANDATORY FIELDS AT LEAST ONE REQUIRED)

  • Open or healed varicose ulcer
  • Active varicose eczema (unresponsive to topical steroids and compression)
  • Recurrent superficial thrombophlebitis requiring NSAID therapy and compression
    • (* Phlebitis/thrombophlebitis is defined as acute onset, tender, hard, lumpy veins due to thrombosis. It is Not just painful veins. Standard treatment is NSAIDs and compression, not antibiotics. Patients should not be referred on first episode unless there is clinical evidence of thrombosis extending up to the groin)
  • A history of venous haemorrhage where there is a likelihood of further bleeding

 

Leg Ischaemia

Most patients with recent onset intermittent claudication will improve spontaneously – especially if they are encouraged to correct known risk factors. Furthermore timely attention to secondary prevention will reduce mortality and morbidity due to cardiac and cerebro-vascular disease in this high-risk group. Patients with mild to moderate intermittent claudication do not require invasive vascular interventions. If you have access to ABPI measurements, then that may help confirm the diagnosis.

Patients with severe intermittent claudication, not improved by a regime of smoking cessation, walking exercise, antiplatelet treatment, statin, weight reduction (as required) should be referred for vascular OP Clinic assessment.

Patients with suspected aortic aneurysm, even without related symptoms, should be referred as an urgent case to the Vascular OP Clinic.
Patients with suspected symptomatic abdominal aortic aneurysm (i.e. recent onset or increasing back pain, acute tenderness of the aneurysm, distal embolism) should be referred as an emergency to the Receiving Surgical Team.

Carotid Artery Disease

Patients with suspected carotid artery disease should be referred urgently if they present with symptoms of stroke, TIA, or amaurosis fugax.

Aortic Aneurysm Template

Addictions Guidelines

Scott McLaughlin

Criteria for Referral to Tier 3 Services

Dependency
Pharmacological
Psychiatry /Psychology
Physical Health Damaged
Alcohol Related Brain Damage
Complex Social / Health Needs
Access to rehabilitation / residential in Patient Interventions

Criteria for Referral to Tier 2 Services

Early Intervention
Harmful / Hazardous Drinking
Drinking Drugs Precipitated by Major Life Events
Counselling / Support Work for Individuals and Families
Family Counselling / Mediation
Non-medical Interventions
Education / Prevention / Information/Advice

 

North Lanarkshire: Definitions for Tier 3: Referral to North Lanarkshire Integrated Service

DependencyUsing alcohol/drugs daily : unable to function without use or consumption
1Pharmacological NeedsDetoxification / substitute prescribing / Antabuse / Disulfiram
2Psychiatric IssuesRequires specialist Psychiatric Input
3Physical HealthAny Addiction Related Health Problem
4Access to Rehabilitation / Residential InpatientAcute mental health care, requiring comprehensive assessment and funding to be identified
5Alcohol Related Brain DamageChanges to the structure and function of the brain resulting from long term consumption of alcohol
6PsychologyRequires specialist Psychological Input, Psychosocial Interventions
7ASP
Adults who have addiction issues which could meet the criteria for Adult Support and Protection		“Adults at risk” are adults who:-
Are unable to safeguard their own wellbeing, property, rights and other interests
Are at risk of harm
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult who are so affected
8Child ProtectionIssues where children may be offered by parental substance misuse
9Complex Social NeedsHomeless / Criminal Justice Involvement / Multi Agency Involvement
10Community Care NeedsComplex needs requiring specialist input: health; family; relationships; problems in taking care of themselves; not coping with everyday events; multiple problems

North Lanarkshire: Common Definitions for Tier 2 Service

Early Intervention:Pre - Dependency
1Non-medical interventionsCounselling / Support Work / Group work / Telephone Support
2Harmful / Hazardous DrinkingHazardous drinking above safer drinking limits. The person has so far avoided significant alcohol-related problems. Harmful - is drinking above safe levels with evidence of alcohol-related problems. May show a mild level of dependence
3Experiential / Recreational drug use:A drug used non-medically for personal enjoyment. Usually used in affecting mental activity, behaviour, or perception, as a mood-altering drug.
4Drinking / Drugs Precipitated by Major Life Events:Individuals using alcohol/drugs to cope with major events, e.g., death, divorce, financial hardship; unemployment
5Counselling / Support Work for IndividualsCounselling involves one person (the counsellor) helping another person (the client) to work through some difficult or painful emotional, behavioural or relationship problem or difficulty
6Counselling / Support Work for significant others / families:Support for significant others who are concerned about a loved one’s drink or drug use. The support enables the significant other to be heard and feel more able to understand and cope with the situation
7ASP
Family Counselling / Mediation		Family counselling / mediation can help reduce conflict which means fewer rows at home and can help everyone cope better with their situation.
8Education / PreventionGroup work / Information leaflets
9Information/AdviceUp to date information e.g. Alcohol Unit calculation, Alcohol / Drug effects on the body

South Lanarkshire: Common Definitions for Tier 2:

Early Intervention:Pre - Dependency
1Non-medical interventionsCounselling / Support Work / Group work / Telephone Support
2Harmful / Hazardous DrinkingHazardous - drinking above safer drinking limits. The person has so far avoided significant alcohol-related problems. Harmful - is drinking above safe levels with evidence of alcohol-related problems. May show a mild level of dependence
3Experiential/recreational drug use:A drug used non-medically for personal enjoyment. Usually used in affecting mental activity, behaviour, or perception, as a mood-altering drug.
4Drinking / Drugs Precipitated by Major Life Events:Individuals using alcohol/drugs to cope with major events, e.g., death, divorce, financial hardship; unemployment
5Counselling / Support Work for IndividualsCounselling involves one person (the counsellor) helping another person (the client) to work through some difficult or painful emotional, behavioural or relationship problem or difficulty
6Counselling / Support Work for significant others / families:Support for significant others who are concerned about a loved one’s drink or drug use. The support enables the significant other to be heard and feel more able to understand and cope with the situation
7Family Counselling / MediationFamily counselling/ mediation can help reduce conflict which means fewer rows at home and can help everyone cope better with their situation.
8Education / PreventionGroup work / information leaflets
Relapse Prevention / Alcohol Brief Intervention
9Information / AdviceUp to date information e.g. Alcohol Unit calculation Alcohol/Drug effects on the body

South Lanarkshire: Definitions for Tier 3: Referral to LAADS or SMT

DependencyUsing alcohol/drugs daily : unable to function without use or consumptionRefer to
1Pharmacological NeedsDetoxification / Substitute prescribing / Antabuse / DisulfiramLAADS
2Psychiatric IssuesRequires specialist Psychiatric InputLAADS
3Physical HealthAny Addiction Related Health ProblemLAADS
4Access to Rehabilitation / Residential In-PatientAcute mental health care, requiring comprehensive assessment and funding to be identifiedLAADS / SMT
5Alcohol Related Brain Damage:Changes to the structure and function of the brain resulting from long term consumption of alcohol.LAADS / SMT
6Psychosocial InterventionsRequires specialist Psychological InputLAADS / SMT
7ASP
Adults who have addiction issues which could meet the criteria for Adult Support and Protection.		"Adults at risk” are adults who:-
Are unable to safeguard their own wellbeing, property, rights and other interests
Are at risk of harm
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult who are so affected.
8Child ProtectionSMT
9Complex Social NeedsHomeless / Criminal Justice Involvement / Multi Agency InvolvementSMT
10Community Care NeedsComplex needs requiring specialist input: health; family; relationships; problems in taking care of themselves; not coping with everyday events; multiple problemsSMT

South Lanarkshire

Teir 3HealthLAADS
Teir 3SocialSMT
Teir 2Non MedicalMeridian

Addictions Referral Template

Acne

Scott McLaughlin

Before referring a patient for acne, they must have met the following criteria:

  • The patient has been treated with 2 courses of oral antibiotics for at least 3 months
  • The patient has essentially normal U and E’s, LFT’s, lipids and plasma glucose. (Please append results if possible)
  • Female patients referred for consideration of Roaccutane therapy should be established on contraception PRIOR to referral. (eg Dianette)

Please ensure that all antibiotics prescribed for acne are listed in the medication page of the referral protocol.

Acne Referral Template