Safer Working: Templates and Resources

This information is based around the BMA Safe Working Guidance document and the  UEMO recommended safe maximum of 25.

INFORMATION FOR PRACTICES TO ADOPT/AMEND AS APPROPRIATE

Reception/Triage tool script

The practice is experiencing high demand for appointments, and we have reached safe working capacity for today.

We are unable to offer any more routine appointments for today; this is to ensure patient safety, and the safety of the healthcare team. A number of alternative options are available for you to access healthcare:

• For routine issues we would suggest contacting alternative services such as NHS 111 online or by phone, your local pharmacy, or urgent treatment centre, which we can signpost you to.
• For Practices who operate a pre-booked appointment facility (Bold text NOT to include in script): "We can offer you our next pre-bookable appointment which is on X date."

We are sorry for this inconvenience, which is beyond our control.

If you have an emergency medical problem that you believe cannot wait, then you should seek help from other NHS agencies including NHS 111, urgent care or through accident and emergency.

Further info for practices to consider (Not in script)

Practices may decide that they are only able to offer urgent medical input for vulnerable groups once capacity is reached.  (Practices to consider what cohorts they may include but may be ones such as):

• any child under 1
• any adult over 65
• anyone on cancer treatment
• anyone on palliative care
• anyone with significant mental illnesses
• anyone with a medical need that results in them being vulnerable
• anyone the practice GPs feel to be vulnerable (shown by a e.g. reminder attached on the patient home screen).

When capacity is reached, practices may decide to ask their reception teams to take patient details and check if they are in one of the vulnerable groups the practice have identified.  The practice may then decide to triage these patents to decide their outcome.

The Directory of Service (DOS) guidance shows you how to change you DOS status when at safe working capacity or when you have a service interruption so 111 and other system partners do not divert patients back to your practice that day.

If you are not currently signed up to an enhanced service to provide 12 lead ECG, please follow the instructions in the Notice of non-commissioned work process-12 Lead ECG document provided by Lincolnshire LMC.

This documents details the steps to take if a patient needs a 12 lead ECG including detailing the correct referral template (Cardiology Investigations Request - ULH) within the Arden's Communciations Template.

It also contains the following additional attachments:

• UTC Admission Letter - If the patient is felt to need an urgent ECG due to the clinical situation.
• LMC notice Letter to ICB-12 Lead ECG - Letter to the ICB giving notice (if not commissioned to provide 12 lead ECG).
• LMC Letter to Cardiac Investigations Informing of Action-12 Lead ECG - LMC Letter to Cardiology informing of GP Practices intention to refer patients for 12 lead ECG provision.
• LMC Letter to all Specialities Informing of Action-12 Lead ECG - LMC Letter to all relevant departments informing of GP Practices intention to refer patients for 12 lead ECG provision.

If using Advice and Guidance is not in the best interest of the patient or the clinicain, refer the patient as normal using eRS with the following Statment.

Advice & Guidance Statement
The use of A&G by general practice is non-contractual and non-commissioned. However, currently, our practice may use A&G for timely single requests for advice from expert specialist colleagues. We do not have capacity or resource to undertake extensive additional investigations as part of this process so should additional investigation be required for you to give advice, please convert this A&G to a referral to be seen in an outpatient clinic

Referrals rejected in favour of Advice & Guidance

If your referral is rejected, please use the following letter to respond the the originator and copy in the LMC and ICB.

Letter to Secondary Care-Advice and Guidance

Chronic Lymphocytic Leukaemia (CLL) is not a commisioned service in Lincolnshire and Monitoring of this condition should be done under specialist supervision to identify any progression at the earliest opportunity.

If you currently monitoring CLL, please follow the instructions in the Notice of non-commissioned work process-CLL document provided by Lincolnshire LMC.

This documents details the steps to take if a patient is currently being monitored in General Practice.

It also contains the following additional attachments:

• SystmOne reports to find patients curently being monitored.
• LMC Letter to Haematolgy-CLL - LMC letter to the haematology explaining why GP Practice patients will be referred back to the specialist.
• Practice Letter to Patient-CLL - Letter to the patients explaining why they are being referred back to specialist.
• Practice Letter to Secondary Care-CLL - Patient letter to the haematology giving notice and returning patients back to specialist.

Below are the letters and informattion available to Practices.

• Lincolnshire MPs - Document containing all the MPs contact details for inclusion in Practice letters.
• LMC Report for Health Scrutiny Committee - Open Report on behalf of Lincolnshire Local Medical Committee (LMC)
• Lord Darzi Independent Investigation of NHS in England - Summary letter from Lord Darzi to the Secretary of State for Health & Social Care
• Patient letter to Lincolnshire MPs - Letter patients can use to send to their MP (contact details above).
• Collective Action Information for Patients - Information to patients about why GP their GP Practice is engaging with the BMA Collective action.
• Findings from Nottinghamshire GP practice sustainability survey - Results from the Nottinghamshire GP practice sustainability survey.

PSA Non-Cancer Monitoring is not a commisioned service in Lincolnshire and Monitoring of this condition should be done under specialist supervision.

If you currently monitoring PSA Non-Cancer, please follow the instructions in the Notice of non-commissioned work process-PSA Non-cancer document provided by Lincolnshire LMC.

This documents details the steps to take if a patient is currently being monitored in General Practice.

It also contains the following additional attachments:

• SystmOne reports to find patients curently being monitored.
• LMC Letter to Urology-PSA_non-cancer - LMC letter to the urology explaining why GP Practice patients will be referred back to the specialist.
• Practice Letter to Patient-PSA_non-cancer - Letter to the patients explaining why they are being referred back to specialist.
• Practice Letter to Secondary Care-PSA_non-cancer - Patient letter to the urology giving notice and returning patients back to specialist.

PSA and MGUS Monitoring is not a commisioned service in Lincolnshire and Monitoring of this condition should be done under specialist supervision.

If you are currently monitoring PSA and MGUS, please follow the instructions in the Notice of non-commissioned work process-PSA_MGUS document provided by Lincolnshire LMC.

This documents details the steps to take if a patient is currently being monitored in General Practice.

It also contains the following additional attachments:

• SystmOne reports to find patients curently being monitored.
• LMC Letter to Urology-PSA / LMC Letter to Haematolgy-MGUS - LMC letters to the urology / haematolgy explaining why GP Practice patients will be referred back to the specialist.
• Practice Letter to Patient-PSA / Practice Letter to Patient-MGUS - Letters to the patients explaining why they are being referred back to specialist.
• Practice Letter to Secondary Care-PSA / Practice Letter to Secondary Care-MGUS - Patient letters to the urology / haematolgy giving notice and returning patients back to specialist.

If you are currently signed up to an enhanced service to provide Shared Care, please follow the instructions in the Notice of SCA process document provided by Lincolnshire LMC.

This documents details the steps to take to give notice on Shared Care.

It also contains the following additional attachments:

• Practice Letter to ICB giving notice - Practice letter to the ICB giving notice on the Shared Care enhanced service.
• Practice Letter to Secondary Care Specialities-SCA - Practice letter to Secondary Care Specialities informing them of the intention to stop Shared Care monitoring.
• LMC Letter to Secondary Care Specialities-SCA - LMC Letter to Secondary Care Specialities informing them of the intentions of GP Practices giving notice of Shared Care monitoring.
• Practice Letter to Patient-SCA - Letter to the patients explaining why they are being referred back to specialist for Shared Care monitoring.

If you are currently signed up to an enhanced service to provide Treatment room, please follow the instructions in the Notice of Treatment Room process document provided by Lincolnshire LMC.

This documents details the steps to take to give notice on Treatment room.

It also contains the following additional attachments:

Practice Letter to ICB giving Notice-Treatment Room - Practice letter to the ICB giving notice on the Treatment room enhanced service.
Practice Letter to Secondary Care Specialities-Treatment Room - Practice letter to Secondary Care Specialities informing them of the intention to stop Treatment room enhanced service.
LMC Letter to Secondary Care Specialities-Treatment Room - LMC Letter to Secondary Care Specialities informing them of the intentions of GP Practices giving notice of Treatment room enhanced service.
Practice Letter to Patient-Treatment Room - Letter to the patients explaining why they are being referred to an alternative healthcare organisation for Treatment room procedures.