Consultant to Consultant Internal Referrals Policy
Internal referrals should be made between consultants in the following circumstances:
1. Clinically urgent problem referred by the GP requires further investigation by a hospital
clinician
For investigation, assessment or treatment of a clinically urgent problem e.g. suspected cancer
when no diagnosis established by the first Consultant.
Example: A patient is referred to colo rectal Surgery with symptoms of bowel cancer and no
bowel cancer is found; the patient needs referral on to another speciality to exclude other
abdominal conditions.
2. Original problem referred by the GP requires further investigation by a hospital clinician
Further investigation, assessment or treatment of the presenting signs and symptoms is required
and
this cannot be carried out by the GP or first Consultant.
Example: A patient with shortness of breath who has been seen by the Respiratory Physician
may need to be internally referred to the Cardiologist for some symptoms.
Patients with minor symptoms should be sent back to their GP e.g. a patient with dizziness should
not be referred from ENT to Neurology unless clinically urgent.
3. Pre-operative Assessment
Patients who have a significant medical problem that is identified at pre-operative assessment; the
condition prevents surgery and requires specialist advice/treatment.
Example: A patient with previously undiagnosed angina.
However, if the patient has a problem that is routinely dealt with in primary care, e.g. diabetes,
hypertension, dermatology, they should be returned to the GP.
4. A&E
Patient diagnosed with a serious underlying condition and the symptoms do not require
Admission
or
Direct referral pathways agreed from Emergency Department and the following specialist
clinics:
Renal colic, Urinary retention, TIAs, DVTs, Fracture clinic, Knee clinic, ENT and
Maxillo Facial clinic, Rapid Access Chest pain clinic, Arrhythmias (to cardiology clinic) and
Seizures - especially first fit.
5. Symptoms which are part of a recognised care pathway
The presenting sign or symptom indicates that the patient will be managed within an agreed
pathway which requires specialist input at the next stage.
Examples: A patient with carpal tunnel syndrome who has a confirmed diagnosis with nerve
conduction studies; a rheumatology patient who needs orthopaedic surgery.
6. Referrals within a Speciality for the Same Condition
The GP has referred to the correct speciality but the wrong Consultant with no charge to be made
for the referral for the right consultant..
If the GP has referred the patient to the wrong speciality and does not fall within the above
categories, the referral should be sent back to the GP for action
7. Where patients do not fall into the above categories
They should be sent back to General Practice. Example: a patient with retinal eye disease who has
been seen by the ophthalmologist should NOT be internally referred to another Consultant for
treatment of diabetes or hypertension (this will usually be identified prior to referral)
8. Return of patients to GPs
When a patient is referred to another Consultant or back to their GP, it is important to ensure that
the patient and the GP are informed who will be responsible for future management. Any delay in
administrative processes should be minimised wherever possible and the GP informed by email or
letter within 5 days.
9. Key Principles
It is expected that all internal referrals will be formally authorised by the Consultant in charge rather
than a junior doctor.
10. Notes
 Referrals may be subject to audit and commissioners may not pay for referrals made in
contravention of this policy.
 Clinical safety considerations must predominate at all times.
 This policy also applies to Consultant to Consultant referrals to external providers.
11. 2016/17 NHS Standard Contract Service Condition 8
This new service condition and for the sake of clarity, we outline below how this is interpreted by
the commissioner.
8.3 If the Provider considers that a Service User has an immediate need for care which is outside the
scope of the Services, it must notify the Service User, Carer or Legal Guardian (as appropriate) and the
Service User’s GP of that need without delay and must co-operate with the Referrer to secure the
provision to the Service User of the required treatment or care, acting at all times in the best interests of
the Service User.
This is accepted by commissioners as an urgent requirement
8.4 If the Provider considers that a Service User has a non-immediate need for treatment or care which
is within the scope of the Services and which is directly related to the condition or complaint which was
the subject of the Service User’s original Referral or presentation, it must notify the Service User, Carer
or Legal Guardian (as appropriate) of that need without delay and must (unless referral back to the
Service User’s GP is required as a condition of an Activity Planning Assumption or Prior Approval
Scheme) provide the required treatment or care in accordance with this Contract, acting at all times in
the best interest of the Service User. The Provider must notify the Service User’s GP as soon as
reasonably practicable of the treatment or care provided.
This must relate to the same body part or presenting complaint eg stomach pain: a referral between
a medical and surgical speciality is acceptable. Dizziness: a referral between ENT and Neurology
is accepted.
8.5 Except as permitted under an applicable Prior Approval Scheme, the Provider must not carry out,
nor refer to another provider to carry out, any non-immediate or routine treatment or care that is not
directly related to the condition or complaint which was the subject of the Service User’s original
Referral or presentation without the agreement of the Service User’s GP.
As an example, a patient referred for osteoarthritis of a knee should not be then seen for pain in
another joint.
Policy Name:
Policy Date:
Ratified by:
Clinical Owner:
Review Date:
Consultant to Consultant Referral Policy
19 April 2016
Clinical Commissioning Committee
Abid Irfan
April 2018