Pathways and referrals

Direct Access Non-Obstetric Ultrasound process

Nottingham City and Nottinghamshire County PCT Cluster has awarded contracts to two new providers of Direct Access Ultrasound: Global Diagnostics Limited and Care UK. The new services are currently being mobilised. Global Diagnostics Limited was the first service to be ready and has been live and accepting referrals since December at five locations in Nottinghamshire. Care UK has also been live at three locations since the end of January. Other providers have now also been qualified and we will advise as soon as locations and start dates are known.

Aims of the service

The aim of the service is to aid early diagnostics and avoid the need for unnecessary referral to secondary care, and to support the provision of care closer to the patient’s home, where this will improve access. Where there are clear secondary care clinical pathways with ultrasound as a core component, and it is more appropriate for this diagnostic to be undertaken as an integral part of the clinical pathway, this will remain in secondary care.

Benefits

  • Provision of services closer to the patient’s home.
  • Improved waiting times – The majority (80%) of scanning to be undertaken within ten (10) working days of acceptance of referral and at an absolute maximum of twenty (20) working days.
  • Quick turnaround on clinical reports – a written clinical report should be sent to the referrer within two (2) working days following the examination and within a maximum of five (5) working days.

Process

Referrals by GPs can now be made to the new service (this started on Monday 10 December 2012) via Choose & Book to any location shown in the Directory of Services. Currently the locations offered to patients by Global Diagnostics Limited operational from 8.30am to 5pm are:
  • The Mary Potter Centre, Hyson Green , Nottingham (Wednesday & Thursday)
  • Bulwell Riverside Centre, Main St, Bulwell (Tuesday)
  • Stapleford Care Centre, Church Street, Stapleford (Monday)
  • Newark Health Centre, Newark (alternative Fridays)
  • Balderton Primary Care Centre (alternative Fridays)
The locations offered to patients by Care UK are:
  • Cotgrave Surgery, Belvoir Health Group (Monday)
  • The Wellsprung Surgery, St Anns Health Centre (Tuesday)
  • Barlborough Treatment Centre (Thursday)
  • Major Oak Medical Practice, Edwinstowe (Friday)
The service will appear on Choose & Book by location under: Specialty: Diagnostic Imaging Clinic Type: ULTRASOUND

For Global Diagnostic services the appointment made in Choose & Book will be a ‘Ghost/Dummy’ appointment and, following triage, the provider’s Booking Team will contact the patient to make a ‘real’ appointment of their choice and provide details of any examination preparation required.

For information the Global Diagnostic Limited Bookings Team contact details are:
Global Central Bookings Team
Phone: 0800 6524157
Fax: 0800 6524159
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

For Care UK services at this time the service is an Indirectly Bookable Service; appointment slots are not available on the system. Create the request, add the referral letter and email the UBRN number to This email address is being protected from spambots. You need JavaScript enabled to view it. . Care UK will then contact the patient to arrange an appointment date and time.

Referrals included in the Direct Access Non-Obstetric Ultrasound Service:
  • General abdominal – includes assessment of the aorta, biliary tract, gallbladder, inferior vena cava, kidneys, liver, pancreas, retro peritoneum and spleen
  • Gynaecology – including trans abdominal and trans vaginal
  • Renal/bladder/prostate
  • Scrotal/testicular
  • Musculoskeletal
  • Vascular
Referring clinicians should consider the appropriateness of the referral based upon the integral nature of the diagnostic and the clinical pathway, in their deliberations with the patient and their choice of provider.

Clinical exclusions:
  • Cancer – any patient with suspected cancer should be referred through the two week wait referral pathway
  • Ultrasound guided procedures
  • Obstetric care

Scans for:

  • Breast
  • Cardiac imaging
  • Chest
  • Ophthalmology
  • Superficial masses or lumps in the neck, axilla or groin; and
  • Thyroid

Other exclusions:

  • Children under the age of 18
  • Non-NHS patients

Clinical reports

All unusual or urgent reports will be telephoned through to the GP so that they can take the appropriate steps to manage/follow up the patient.

Unfortunately, at this time, providers are unable to send the required messaging to enable direct reporting into GP practice systems. We appreciate that this will require scanning of the reports into your systems, but some providers have identified a solution and are in the process of changing their systems to enable the required messaging to be available in early 2013 and will continue to seek a quicker solution. In the meantime, the reports will be available via NHS Mail, fax or post and practices should express their preferred route when making the referral.

Referrals to secondary care

When making onward referrals to secondary care following a Direct Access Ultrasound, GPs should ensure that the clinical report from the Direct Access Ultrasound is attached to the referral. If an image is required to be made available then the report will detail how to contact Global Diagnostics for this to be arranged. The wording on the report will read similar to the following:

‘Should any patient require referral to secondary care, the images relating to this examination can be made available via the National Image Exchange Portal (IEP). To instigate this transfer, please telephone Global Diagnostics on Freephone 0800 6524157. It may be advisable to confirm in the onward referral letter that images have been made available via this route. Please also ensure that this report is included within your referral.’

NUH/Treatment Centre referrals only:

If an image is requested from the provider to be sent to NUH or the Treatment Centre then an IEP request will need to be made in GP access or ICE to ensure that NUH pick up the image. Appendix 1 below shows the screen shot of how this should be requested.

Further information

If you require any further information or wish to give feedback or make suggestions about the instructions or process please contact Ann Berry, Acute Contract Manager, NHS Nottingham City on This email address is being protected from spambots. You need JavaScript enabled to view it. Tel: 0115 883 9557.

Appendix 1

To advise NUH or Treatment Centre that you have requested an image to be sent via the Image Exchange Portal:
Within GP ACCESS:
  1. Choose Referral Type of “Image Exchange Portal Refs”
  2. Check Provider Name of Direct Access Ultrasound (i.e. Global or Care UK)
  3. Add in the Clinical Details the name of the consultant to whom referral has been sent who requires access to the image
Within ICE:
  1. Click on Radiology Specials Tab
  2. Check IEP Image Import
  3. Answer the provider question that pops up on the screen
  4. Continue with request
  5. In the Global Clinical Details enter the name of the consultant to whom referral has been send who require access to the image.