Stage 1: Pre-referral principles

Prior to referral, a meaningful conversation about the intervention and potential implications of referral needs to happen so the patient feels fully informed of benefits, risks, alternatives and what happens if they do nothing.

Below are links to resources relevant to this stage of the pathway, with a brief description of their content.

Realistic conversations: shared decision making in practice Click to go to another website  

This is an eLearning module available on Turas. It provides guidance for health and social care staff on Shared Decision Making (SDM).

Provider

  • NHS Education for Scotland

Resource type

  • eLearning module

User/audience

  • Primary care
  • Clinicians
  • Community link workers

Aims/learning outcomes 

  • Describes shared decision making and why it’s important; identifies barriers.
  • Explains the importance of presenting benefits and harms of a treatment in ways that people can understand and use to make decisions.
  • Explains how to use the BRAN (Benefits, Risks, Alternatives, do Nothing) questions with a patient.
  • Enables learner to structure a collaborative shared decision-making conversation.
  • Enables learner to reflect on whether a good conversation has taken place.

Benefits

  • Shared decision-making helps to ensure that the decisions about a person's care support the outcomes that matter to them. 

How to access this resource

  • Access via your TurasClick to go to another website account.

Estimated time for training

  • 1 hour.

 

What matters to you conversations: a 'how to' guide Click to go to another website

Sets out why these conversations are important and key actions to take before, during and after the conversation.

Provider

  • EOLC Partners Think Tank

Resource type

  • Webpage

User/audience

  • Primary care
  • Clinicians
  • Public

Aims/learning outcomes

  • Supports staff to improve communication, human connection and avoid personal judgements when having in-depth or focused conversations.

Benefits

  • Good conversations give people permission and opportunity to be honest about what matters most to them.

How to access this resource

 

Scotland’s House of Care - Health and Social Care Alliance Scotland  Click to go to another website

Provider

  • Health and Social Care Alliance Scotland

Resource type

  • Learning module, via NHS Education for Scotland (NES).

User/audience

  • Primary care
  • Clinicians

Aims/learning outcomes

  • Support and planning tool which encourages and enables meaningful, person-focussed conversations which have a neutral power balance. A person’s data and information are shared with them prior to their conversation which prevents people from being forced to make quick decisions on health at consultation stage.

Benefits

Enables patients to:

  • be an expert in themselves.
  • know their ‘numbers’ and what is important.
  •  focus on areas that are important to them.

How to access this resource

  • Practice based small group learning modules via NHS Education for Scotland (NES).

 

it's ok to ask Click to go to another website

This webpage provides resources for patients to help them know what is going on with their own healthcare.

Provider

  • NHS inform

Resource type

  • Webpage

User/audience

  • Public

Aim/outcome of resource

  • Helps patients to ask the right questions in preparation for their upcoming appointment.
  • Patients will better understand what’s going on with their own health and to help them make the right decisions.

Benefits

  • Supports people with realistic medicine, and right decisions.
  • May help people not to join lists if it’s not the best route forward.

Access requirement

 

Communication resources Click to go to another website

These resources, available on Turas, help develop skills and knowledge to improve communication in your services and workplaces. 

Provider

  • Turas

Resource type 

  • eLearning modules

User/audience

  • Staff with Turas access

Aims/learning outcomes

  • Aimed at health, education, social work and voluntary sector staff who want to understand how to improve communication and services for people with communication support needs, this resource features clips of people with communication support needs.

Benefits

  • Supports in having conversations regarding health and wellbeing, support in capacity and consent regarding discussions between patient and clinicians.

How to access this resource

  • Access via your TurasClick to go to another website account.

Estimated time for training

  • There are a number of modules that take approximately 30 minutes each to complete.

 

The Health Literacy Place Click to go to another website

Provides resources for staff around having discussions with people.

Provider

  • The health literacy place

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Supports staff to improve communication, human connection and avoid personal judgements when having in-depth or focused conversations.

Benefits

  • Gives people permission and opportunity to be honest about what matters most to them.

How to access this resource

 

National Pathways Click to go to another website

Provides information on national pathways.

Provider

  • NHS Scotland, Centre for Sustainable Delivery

Resource type

  • Webpage

User/audience

  • Clinicians

Aims/learning outcomes

  • The CfSD has a pathway process for development of pathways. This would include referral guidance, patient information, when to refer.

Benefits

  • Supports professionals when making referrals.

How to access this resource

Consider early on prior to referral being made, type of support patient will likely require during Waiting Well period, including access to healthcare.

Below are links to resources relevant to this stage of the pathway, with a brief description of their content.

Waiting Well risks & resilience (HOW) tool

This is a tool to be used by the professional who knows the person well for making the referral for a possible wait.

User/audience

  • Clinicians

Resource type

  • Appendix B in Waiting Well toolkit.

Aims/learning outcomes

  • Supports professional to identify which individuals waiting may benefit from more intensive support during the active Waiting Well period.

Benefits

  • Enables patients at higher risk of poorer outcomes to be identified and proactively supported.

How to access this resource

Access as Appendix B in Waiting Well toolkit.

 

6 P's: prepared, patient, prepared professional, prepared process Click to go to another website.

Suggestions of support/questions to consider for the 6P's.

User/audience

  • Primary care
  • Public

Resource type

  • prompt to action 

Benefits

  • Patients at risk of not accessing available services are identified and proactively supported.
  • Ensure practices have access to support such as bus tokens as well as protected time/staff/capacity to undertake Waiting Well conversations.

How to access this resource

Provision of general information on waiting well to consider lifestyle changes earlier than going onto the list.

Below are links to resources relevant to this stage of the pathway, with a brief description of their content.

Waiting Well hub  Click to go to another website 

This is a webpage on NHS inform with access to the Waiting Well pages. Other NHS inform pages as relevant.

Provider

  • NHS inform

Resource type 

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Raising people’s awareness of what is possible to support their care journey.
  • Encourages shared decision making about care supporting the realistic medicine approach.
  • Provides information on how to wait well and lots of self-help material and signposting to local and national services.
  • Supports people to have a health and wellbeing plan at the start of waiting to enable the waiting period to be an active phase supporting health and wellbeing. 
  • For those who are socially vulnerable, also making it easy link to the relevant sections on the NHS inform website for Waiting Well e.g. money, work and home Click to go to another website

Benefits

  • Supports patients with health and wellbeing improvement earlier in their journey, improving prehab and rehab.

How to access this resource

 

Dental health link out to external website

This is a webpage on NHS inform which provides dental health advice. 

Provider

  • NHS inform

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Providing advice on oral health to ensure there are no outstanding dental problems that would be best dealt with pre-surgery for example heart valve or joint replacements. (Also pre-cancer surgery or other treatment)
  • The dental health NHS inform link gives general information on taking care of oral health. If patients are registered with a dentist, they should be encouraged to contact their dentist for a check-up prior to surgery.
  • If they are not registered, each Board has a dental advice line. There is a list of numbers to call for each Board – they are currently listed on NHS inform on the dental emergencies page link out to external site
  • For those on waiting lists, consideration should be given to introducing dental prevention into care plans for patients (including dental patients) on long waits for procedures.

Benefits

  • Help patients improve health before surgery and understand the risks of poor oral hygiene during and post-surgery for certain procedures.

How to access this resource

 

Mind to Mind, NHS inform link out to external website

An online resource for mental health and wellbeing with links to local services. Provision of mental health and wellbeing support.

Provider

  • NHS inform

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Online resources for mental health and wellbeing with links to local services

Benefits

  • Helps patients with mental health and wellbeing improvement earlier in their journey, improving prehab and rehab

How to access this resource

 

iThrive Edinburgh link out to external site

An online resource for mental health and wellbeing with links to local services. Provision of mental health and wellbeing support.

Provider

Health in mind

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Online resources for mental health and wellbeing with links to local services

Benefits

  • Helps patients with mental health and wellbeing improvement earlier in their journey, improving prehab and rehab

How to access this resource

 

Eastspace link out to external website

An online resource for mental health and wellbeing with links to local services. Provision of mental health and wellbeing support.

Provider

  • Health in mind

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Online resources for mental health and wellbeing with links to local services

Benefits

  • Helps patients with mental health and wellbeing improvement earlier in their journey, improving prehab and rehab

How to access this resource

 

Thistle foundation link out to external site

An online resource for mental health and wellbeing with links to local services. Provision of mental health and wellbeing support.

Provider

  • Thistle foundation

Resource type

  • Webpage

User/audience

  • Public

Aims/learning outcomes

  • Online resources for mental health and wellbeing with links to local services

Benefits

  • Helps patients with mental health and wellbeing improvement earlier in their journey, improving prehab and rehab

How to access this resource

 

Improving the Cancer Journey, RefHelp link out to external site

Provision of support focussed on non-clinical issues.

Provider

  • NHS Lothian 

Resource type

  • Webpage

User/audience

  • Public
  • Primary care
  • Community link workers
  • Clinicians

Aims/learning outcomes

  • Lothian Improving the Cancer Journey (ICJ) Service is a Macmillan-funded, link worker service. Offers support with money, housing issues, work, caring responsibilities, physical concerns and emotional concerns.

Benefits

  • Helps identify main concerns of patient. Link workers can then have supportive conversation and signpost to relevant services. Co-create a care plan which can be shared with other health professionals.

How to access this resource

Provision of guidance and support on making high quality referrals.

Below are links to resources relevant to this stage of the pathway, with a brief description of their content.

RefGuide Click to go to another website

Webpage with information on how to access each service, as well as concise referral guidance for common referral areas. Also signposts to relevant national and/or guidelines and useful resources.

Provider

  • NHS Tayside

Resource type

  • Webpage

User/audience

  • Primary care

Aims/learning outcomes

  • For GPs to help them navigate the huge array of services and support them in making high-quality referrals to those services.
  • For specialists, to help them provide consensus guidance and direction to help GPs make the best use of their service.

Benefits

  • Reduces risk of “referral bingo”.

How to access this resource

 

RefHelp Click to go to another website

Webpage with information on how to access each service, as well as concise referral guidance for common referral areas. Also signposts to relevant national and/or guidelines and useful resources.

Provider

  • NHS Lothian

Resource type

  • Webpage

User/audience

  • Primary care

Aims/learning outcomes

  • For GPs to help them navigate the huge array of services and support them in making high-quality referrals to those services.
  • For specialists, to help them provide consensus guidance and direction to help GPs make the best use of their service.

Benefits

  • Reduces risk of “referral bingo”.

How to access this resource

 

National pathways link to external website

Webpage with information on how to access each service, as well as concise referral guidance for common referral areas. Also signposts to relevant national and/or guidelines and useful resources.

Provider

  • NHS Scotland, Centre for Sustainable Delivery

Resource type 

  • Webpage

User/audience

  • Primary care

Aims/learning outcomes

  • For GPs to help them navigate the huge array of services and support them in making high-quality referrals to those services.
  • For specialists, to help them provide consensus guidance and direction to help GPs make the best use of their service.

Benefits

  • Reduces risk of “referral bingo”.

How to access this resource

 

Potential technical development: SCI-gateway banners

User/audience

  • Primary care

Aims/learning outcomes

  • Prompt GPs with relevant information and basic questions to ask during consultation if making referral. For example, do they need:
    •  support of a link worker to facilitate attendance?
    • a welfare advisor if they are unable to work and are not eligible for sick pay/benefits?
    •  alternative methods of receiving information about appointments?
    • support with an interpreter, etc?

Benefits

  • Ensures completeness of information for secondary care.

 

Consideration of barriers in accessing care particular to patient

User/audience

  • Primary care

Resource type

  • Prompt to action

Aims/learning outcomes

  • With consent from the patient, include information in the referral that alerts the specialist team that the person may need additional support to be able to attend the appointment.

Benefits

  • Improves interface between primary and secondary care