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REMEDY : BNSSG referral pathways & Joint Formulary

Referrals during COVID-19

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******UPDATE 02.04.20*******

  • Remedy has been advised that GPs should stop all routine referrals to secondary care with immediate effect.
  • PRIME endoscopy, CARE UK, Nuffield and New Medica will also not be taking any new referrals.
  • Urgent referrals may be triaged and returned to GP with advice.
  • HOT clinics should still operate as normal.
  • GPs should continue to refer via 2WW if referral criteria are met.
  • Existing referrals and follow ups may be triaged by consultants and returned to GPs where appropriate.
  • Dental Hospital closed to walk in referrals
  • Routine Radiology has been suspended

Please use Remedy guidelines or Advice and Guidance services where available. Further information on how to access advice and support will follow.

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 Guidelines page for further info
  • Bristol Eye Hospital - please see Ophthalmology and COVID-19


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 watch this space for information.


To enable the secondary care teams to give the best advice possible when requesting advicd and guidance please consider the following points:

  • Give a clear concise history and examination findings- avoid cutting and pasting long lists of consultation notes that are not relevant to the problem in hand.
  • Include relevant results, investigations and recent correspondence if appropriate but avoid multiple attachments that can take time to download and make the triage process more cumbersome.
  • Ask a clear clinical question and avoid ambiguity.
  • Avoid requests for complex patients known to an individual consultant as they are unlikely to be the consultant giving the advice and may not have easy access to details of previous contacts with the patient. In these cases consider writing or emailing the relevant secretary directly.

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 as normal in line with existing criteria.