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Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

E-Vetting Guidance (907)

Warning Warning: This guideline is 288 day(s) past its review date.

Please report any inaccuracies or issues with this guideline using our online form

This guidance has been developed to assist the vetting process for GGC gynaecology referrals. The guidance aims to ensure there is appropriate and consistent access to gynaecology services in GGC.

1. Downgrading of referrals from urgent to routine

All the following points must be completed:

  • GP must have examined patient, the examination must have been complete and normal
  • Outline reasons to the referrer for downgrading (e.g. normal smear, normal cervix, premenopausal with no risk factors so low risk for endometrial malignancy etc.)
  • Suggest interim treatment if appropriate
  • Advise GP to re-refer as urgent if symptoms persist or deteriorate

2. Suitability of referrals for a virtual appointment

  • GP has done a vaginal examination that is normal
  • Up to date with normal smear
  • Up to date BMI
  • No treatment or no failed treatment initiated by GP
  • If patient requires interpreter including BSL, consider suitability ( Attend Anywhere can facilitate remote interpreter)
  • Does not need USS or biopsy ( many patients will have been scanned prior to referral)
  • A virtual appointment can be offered even if an examination or scan is needed if it is felt that explanation and discussion virtually beforehand would significantly shorten the face-to face time.

3. Suitability for replying to referral with standardised advice

  • GP has examined patient and examination is normal
  • Normal smear where appropriate
  • No further investigation required before treatment/ management initiated
  • Standardised advice is available for HMB, PCOS, vulval itch, menopause/HRT, incontinence /prolapse, IMB/PCB

  • PMB
    Has uterus/cervix- vet as USOC/URGENT- PMB/onestop North (clinic F)

    PMB- no uterus/cervix- GP has NOT examined or examination abnormal- vet as USOC/URGENT- general gynaecology

    PMB- no uterus/cervix- GP has examined and normal vault and vulva- Downgrade to ROUTINE, vet to general gynaecology and ask GP to check for haematuria

 

  • HMB 
    Women <40 can be vetted to a general clinic. Women ≥40 should be vetted to a one-stop clinic

    Women <45 with HMB with no risk factors for endometrial pathology / normal examination should be vetted as ROUTINE

    Women aged 40-44 with HMB AND persistent IMB or PCB, with no other risk factors for endometrial pathology should be vetted as ROUTINE

    Women aged 40-44 with HMB AND persistent IMB or PCB AND one or more additional risk factors for endometrial pathology should be vetted as URGENT

    Women ≥ 45 with no irregular bleeding, normal examination and no additional risk factors for endometrial pathology should be vetted as ROUTINE

    Women ≥45 with any additional risk factors for endometrial pathology OR persistent IMB / PCB OR treatment failure (continual use of hormonal treatment for 6 months) should be vetted as URGENT

 

  • IMB
    Women <40 with normal examination should be referred back to GP with advice to review hormonal contraception and exclude infection. If starting / changing hormonal contraception or treating infection is not successful, then vet as ROUTINE to general gynaecology.

    Women ≥ 40 with persistent IMB with normal examination, but who have risk factors for endometrial pathology (eg PCOS, BMI>40, current / past tamoxifen use) should be vetted as URGENT.

    Women ≥40 with no risk factors – vet as ROUTINE

 

  • PCB
    If appearance suspicious /consistent with cervical cancer vet as USOC to colposcopy.

    If abnormal cervical screening, vet to colposcopy as per usual protocol

    Women < 40 with normal smear / examination should be offered STI screen. Consider change of OCP / trial of Relactagel®. If ineffective, vet as ROUTINE to gynaecology or colposcopy as per local service provision.

    Women ≥40 – vet as URGENT 

 

  • PCOS
    Most referrals can be managed by sending standardised advice to GP- if an appointment is felt necessary this should be VIRTUAL unless there is significant menstrual disorder (e.g. requiring LNG-IUS etc)

 

  • CERVICAL POLYP
    Asymptomatic, normal smear- vet to ROUTINE general gynaecology appointment. If symptomatic (e.g. PCB/IMB), < 40 years vet as ROUTINE to general gynaecology, >40 years vet as ROUTINE to PMB/onestop North (clinic F)

 

  • VULVAL ITCH/DISCOMFORT
    If GP has examined and no focal abnormality (e.g. ulcer) and no treatment, send referral back to referrer with standardised vulval care advice.

    If examination by GP is abnormal or there has been treatment failure, vet to general gynaecology (vulva clinics are tertiary referral only). Grade depending on appearance of abnormality.

 

  • INCONTINENCE/PROLAPSE
    Current NICE guidance is for conservative management in the first instance- refer to SPHERE bladder and bowel service. OAB symptoms can be managed with medication (send GP standardised advice). Women with failed management or treatment should be vetted as routine to urogynaecology.

 

  • PELVIC PAIN/ QUERY ENDOMETRIOSIS
    If GP has examined and normal smear, vet as ROUTINE to virtual appointment

 

  • STERILISATION REQUEST
    Vet as routine to virtual appointment- send referral back to referrer if BMI >35 or no BMI recorded

 

  • MENOPAUSE/HRT
    Some referrals can be dealt with by sending standardised advice to GP. If appointment needed vet as routine to VIRTUAL appointment

 

  • ULTRASOUND
    Some referrals can be vetted directly to gynae USS ( e.g. asymptomatic simple cyst < 5cm, or radiology have suggested TVUSS) 

 

  • FINDING OF POSTMENOPAUSAL INCIDENTAL INCREASED ENDOMETRIAL THICKNESS/FLUID IN ENDOMETRIAL CAVITY
    In the absence of PMB vet as ROUTINE to PMB/onestop North (clinic F)

RE-GRADING OF USOC (URGENT SUSPICION OF CANCER) REFERRALS

  • It has been agreed that during COVID-19 pandemic Urgent Suspicion of Cancer (USOC) referrals can be re-prioritised at vetting to urgent or routine where a referral does not meet the Scottish Cancer Referral Guidelines
  • Scottish Cancer Referral Guidelines can be accessed at: http://www.cancerreferral.scot.nhs.uk/
  • An automated letter will be sent to Primary Care noting re-prioritisation. Thus ensuring clear communication back to GP whilst minimising impact on vetting clinician in dictating letter.
  • A 2 stage vetting process has been implemented in Trakcare:
    1. Select ‘downgrade of cancer’ in vetting outcomes, this will generate letter to GP; then
    2. Re-grade referral and assign appropriate vetting outcome

Editorial Information

Last reviewed: 01/02/2021

Next review date: 30/06/2024

Author(s): Claire Higgins.

Approved By: Gynaecology Clinical Governance Group

Document Id: 907