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REMEDY : BNSSG referral pathways & Joint Formulary

Referrals (Adult) during COVID-19

Checked: 02-06-2020 by Rob.Adams Next Review: 30-10-2020


******UPDATE 17.04.20*******

As a result of COVID-19 please see the following key messages regarding referrals: 

  • Routine Referrals: All routine referrals should cease and be held by practices (guidance attached on how to manage this patient list)
  • Key updates: REMEDY will be the central place for the most up to date information
  • Suspected Cancer: 2ww referral pathways will remain as present with the exception of the cessation of direct access endoscopy . Please use the normal 2ww form via eRS
  • Same day urgent: Hot clinics to remain open however access routes and location may change. Updates will be on Remedy
  • Advice & Guidance: Some form of A&G will be available for all specialties, but should be used judiciously in line with guidance (Please see Advice and Guidance services)
  • Urgent referrals: Will be accepted by providers but will be subject to triage
  • Referral support service and REMEDY: Will be the place for up to date referral information and advice (see REMEDY and also
  • Re-opening referrals pathways: Services will re-open access to routine referrals as they free up capacity from COVID response. This will be earlier for some specialties than others. Communications will follow and REMEDY will be updated as services re-open.
  • Routine outpatient appointments: Many secondary care appointments will be cancelled or deferred. Acute providers are contacting patients and will continue to manage these patients on their lists and re-book as soon as possible. Patients may present in primary care if their condition deteriorates in the meantime. GPs may wish to manage this but will have access to A+G or urgent referral.
  • GPs are advised to supply their mobile phone number for calls, texts or whatsapp comms from the consultant. We would like to encourage clinical discussion around more complex cases as this will increase the value of the advice consultants can give.
  • Responsibility to activate a referral or re-present to practice should not be delegated to the patient.

Please see the current position following agreement with the acute trusts community providers and primary care regarding management of elective care during the COVID 19 pandemic crisis with effect from 25th March 2020  (updated1.5.20) for full details.

Please use Remedy guidelines or Advice and Guidance services where available.

We will endeavour to keep Remedy up to date with changes to services as and when they occur (and when we are informed). Please feedback (Feedback button on top right of screen) to us if you are having problems getting up to date information regards particular services. We will try and provide any help or support that we can. 

Advice for Specific Services

  • Vascular Surgery - COVID-19 impact. This document is to provide a BRIEF description of how we aim to continue to deliver a specialist vascular and diabetic foot service during the coronavirus pandemic for primary care
  • Neurology (NBT): The neurologists at NBT now have an Advice and Guidance service available to access via eRS for all BNSSG practices. There is also a telephone line for more urgent advice and support for clinicians.
  • Cardiology (BHI): All walk in ecg and routine  referrals for cardiac investigations are suspended. ECG's done in practice can be forwarded via A and G for reporting if needed. The Rapid Access Chest Pain Clinic will continue as normal. Please use the existing Advice and Guidance services for all other concerns.
  • Community Paediatrics: No longer accepting  new referrals unless urgent. See letter on CCHP website for details.
  • Vasectomy: The vasectomy service will no longer accept routine referrals from 15 April
  • Dental Hospital Closed to walk in referrals.
  • Radiology - please see Radiology during COVID-19 page for further information.
  • Bristol Eye Hospital - please see Ophthalmology and COVID-19
  • Unity Sexual Health Services - Information for Primary Care Updated 28-05-20.
  • Bristol ROADS Shared Care - urine screens required to commence Shared Care Opioid Substitution Treatment. See Shared Care page for updated information
  • Community Referrals will be restricted with most routine services suspended.
  • CARE UK, Nuffield and New Medica will not be taking any new referrals.PRIME will not be taking new referrals for endoscopy but will continue to offer a telephone advice service for patients (refer via eRS)


Routine Referrals

Please see below a copy of the email that will be sent to GPs who refer any patients routinely:

Dear Colleague

During the current COVID-19 pandemic the acute trusts are restructuring to manage patients in high dependency and ITU. Therefore we have been advised that they cannot accept routine referrals until further notice. Most other providers are now also closed to new referrals.

We advise that you use Remedy guidelines or existing Advice and Guidance services where appropriate and hold your patient in primary care until the situation has improved.

We appreciate the difficulties that this may cause but unfortunately we have no other option in these unprecedented circumstances.

The CCG is progressing discussions with the acute trusts on how practices can be supported in managing patients over the coming weeks. Please see Remedy for regular updates and alternative sources of advice.

If you believe that the patient needs to be seen urgently and that they are likely to come to harm if a referral does not proceed then please resubmit your referral with further information. Please note that these referrals may be triaged and returned to you with advice. Please warn your patient that if a referral is accepted then it is likely that the patient will have a telephone rather than a face to face appointment. Please therefore ensure that your referral contains an up to date telephone number for the patient or their carer.

2WW referrals should proceed as normal but do not use this route of referral unless criteria are met.

We will cancel the referral from your worklist at this stage. Please let us know if there is anything else we can do to support you. The Referral Service team continue to work remotely and can be contacted via email and we will endeavour to reply within 24 hours.

Kind Regards and stay well


Existing Referrals

Referrals that are already been accepted by secondary care may be deferred - trusts will be writing to patients to inform them of this. If concerns are raised by patients and a more urgent referral is thought necessary then please consider using existing advice and guidance services or contacting trusts to request that the referral be reviewed urgently.

Please warn patients that even if they are referred urgently they may not be seen quickly over the coming weeks. They may also be given a telephone appointment rather that a F2F appointment initially.

Advice and Guidance and RAS

In order to support GPs some trusts will be adding additional specialties to existing Advice and Guidance services or Referral Assessment Services (RAS) via eRS. Other trusts may be using direct access email accounts for advice. Please see Advice and Guidance - Secondary Care for more information. There should be some form of advice & guidance available for all specialties. If you cannot find the service you require please inform the Referral Support Service.

Urgent and 2WW Referrals

Urgent referrals should still be sent via eRS but consider guidelines and A and G services prior to referral if appropriate. Please be aware that these referrals may be triaged by the Referral Service and/or trusts to check they are appropriate before they are accepted.

HOT clinic referrals can continue to be sent via usual routes 

2WW referrals should proceed along normal pathways in line with existing criteria. (Direct access Endoscopy requests via ICE for suspected cancer are currently suspended so refer using the 2WW form via eRS.)


Patient information

Please see the CCG page for latest updates for patients:

Health Services during Coronavirus