Referral Guide

The Trust's AEC at Darent Valley Hospital offers a streamlined diagnosis and treatment for appropriate patients on the same day. In most cases, patients will not require a hospital admission and will be sent home with ongoing clinical care. To make a referral please call the AEC Coordinator on 07925 173747.

Suspected cancers should be referred using the E-referral Service (eRS). If you have any questions, concerns or your required service is not available on eRS, please email dgn-tr.cancerreferral-dvh@nhs.net or call 01322 428216.

For Healthcare Professionals:

If you are a Bexley or DGS GP then ALL referrals will now be via E-RS and will not be accepted via email. You will need to complete a referral form and your referral will be triaged to a Paediatric Consultant or the nurse led childhood constipation team.

• Service Name: Paediatric - Childhood Constipation & Soiling Service (RAS)  - Dartford & Gravesham NHS Trust-RN7
• Speciality: Children & Adolescent Services
• Clinic Type: Gastroenterology

For areas outside of the above ICB’s, any email referral will be placed into a triage system

Details on how to refer a patient to EPU and the referal form are available HERE.  

For Healthcare Professionals:

ALL EXTERNAL referrals will now be via E-RS and will not be accepted via email. You will need to complete the referral form template on the link below and your referral will be triaged. Please note this will not affect INTERNAL REFERRALS as we will still be accepting requests on PAS via Order Comms for internal requests.

You can find our service as follows:

·Service Name: ECHO Diagnostic Test (RAS) Service - Dartford & Gravesham NHS Trust-RN7

·Speciality: Diagnostic Physiological Measurement

·Clinic Type: Cardiac Physiology - Echocardiogram

Click HERE for the Echocardiography Request Form.

The statutory implementation of medical examiner system will be coming to all Dartford and Gravesham GP practices on 9 September 2024, (under legislation in the 2022 Health and Care Act).

So far, we have now partnered up with most of the local practices in Dartford and Gravesham areas – thank you to those who have already on boarded with us!

If your practice has not yet on boarded with us, below we have listed just some of the benefits to your practice that this would bring:

• Supporting the bereaved: For GPs, this can reduce workload by taking care of enquiries and follow-ups. This does not replace GPs speaking with families or next of kin, and providing the support they wish to give.
• Support with MCCD completion: specialist training and understanding of the MCCD and death certification processes means medical examiners can reduce the burden associated with coroner notifications from GP practices.
• Supporting work with coroners’ offices: medical examiners are a source of medical advice for coroners, which should reduce requests from coroners for GPs to discuss cases or to advise on wording.
• Reduce administration: if agreed locally, medical examiner officers can carry out administrative tasks relating to death certification. Medical Examiner officers can complete coroners referrals to reduce the burden
• Timely completion of scrutiny: medical examiners complete their scrutiny in a timely manner to facilitate registration within five days.
• Examination of the deceased: the Coronavirus Act introduced easements to the process of certifying deaths. There is no new mandatory requirement for examination of the deceased by GPs in the medical examiner system.
• Complex cases: Medical examiners will support the doctor completing the MCCD, drawing on their extensive knowledge gained through training and regular exposure to more complex scenarios to support and advise. This will assist GPs in completing MCCDs accurately in cases that are more complex.
• Urgent release of the body: medical examiners will develop positive relationships with contacts in faith communities, and will be able to support GPs if there are requests for urgent issue of the MCCD.
• Clinical governance; where issues are detected, medical examiners will offer non-judgmental feedback. Their aim is not to find fault or review in unnecessary detail.
• Concerns and learning; a key objective for the medical examiner system is to identify constructive learning to improve care for patients.

So what are you waiting for? Get in touch to work with us today! Contact the medical examiner office on 01322428170

Community Referrals to the Medical Examiner office

Here you will find guidance on how to send us referrals of community deaths to be reviewed by a Medical Examiner.

From April 2024, it will be statutory that every GP will need to refer deaths to be reviewed via the Medical Examiner system, and to help you stay ahead of the game, we have listed brief points below, along with a more in depth ‘how to video’ below.

Main things to note when completing patient summary via DXS:

· To make it easier for you, the referral automatically populates demographic details and pulls past medical history from Emis.

· Important information to be completed:

o Date of Death

o Time of Death

o Verifying practitioner

o Brief summary (A completed summary will ensure we can complete a coroners referral on your behalf)

o Proposed cause of death

o Dr details who will be completing the MCCD, including their work mobile number

· Next of kin details are useful as you might have more up to date details than us

· Please highlight any cases that need URGENT attention i.e Faith deaths, GPs on annual leave, patient has NOT been seen alive by a GP in the last 28 days

Once you have completed the referral form via DXS, it can be automatically emailed to us at the Medical Examiner’s office.

DXS Tutorial video

DXS VIDEO (Completing the Summary of Death Certification Form using DXS) ​​​​​​

In this tutorial video, it will instruct you how to access the Summary of death Certification Form via Emis/DXS and highlight the sections that are automatically populated and the required sections to complete.

Criteria for Coroner’s referral

a) The registered medical practitioner suspects that the person’s death was due to:

I. Poisoning, including by an otherwise benign substance;

II. Exposure to or contact with a toxic substance;

III. The use of a medicinal product, controlled drug or psychoactive substance;

IV. Violence;

V. Trauma or injury;

VI. Self-harm;

VII. Neglect, including self-neglect.

VIII. The person undergoing a treatment or procedure of a medical or similar nature; or

IX. An injury or disease attributable to any employment held by the person during the person’s lifetime;

b) Despite taking reasonable steps to determine the cause of death, the registered medical practitioner considers that the cause of death is unknown;

c) The registered medical practitioner suspects that person dies while in custody or otherwise in state detention;

d) The registered medial practitioner reasonably believes that there is no attending medical practitioner required to sign a certificate of cause of death in relation to the deceased person;

e) The registered medical practitioner, after taking reasonable steps to ascertain the identity of the deceased person, is unable to do so.

f) Where the deceased was not seen alive by any registered medical practitioner in over 28 days.

OUR PROMISE TO YOU

Once you have completed a referral to us, containing all the relevant information require, we will endeavour to complete the review of your referral within 24 - 48 hours.

We have medical examiners and officers available daily who can also advise on appropriate coroner referrals, acceptable causes of death and answer any questions you may have.

Please see below links for further information:

The Royal College of pathology COD list provides guidance regarding causes of deaths that will be accepted by the Registrar.

• Royal College of Pathology COD list
• Kent and Medway Coroners
• DVH Mortuary
• Medical examiner office home page
• Bereavement Service

Primary Care Headache Management - Guidance for the GP

• Part 1

• Part 2
• Part 3
• Part 4
• Part 5

• Exclusions Guidance Referencing for Referrers for e-RS referrals

As of 5^th March 2021, Darent Valley Hospital will be able to accept GP patients Requests opening times are  Monday to Fridays 08:30 – 19:00 .  Please note that due to ongoing social distancing measures and continuing restrictions for other services there is a security presence on the door.

Can you ensure that if a patient referred Darent Valley Hospital that they attend with a signed paper copy of their request to ensure entry.   This allows the hospital to ensure that we can kept patient footfall to a minimum.  If the patient does not have a physical copy of their request they may be denied access to Darent Valley hospital.

Radiology would like to reinforce the following:

• It is not acceptable for any patient to have their radiology request emailed directly to them.  This is a radiation protection risk and should be avoided. 
• If the patient cannot collect a physical copy of their request then they can still attend either Gravesend community hospital or Queen Marys Sidcup hospital providing the GP has emailed the request. ​​​​​

• Darent Valley Hospital Monday – Friday 8.30am – 7pm: email : dgn-TR.radiologydvh@nhs.net 
• Gravesend Hospital   Monday – Friday  8.30am  – 4.30pm: email:  dgn-TR.radiologydvh@nhs.net 
• Queen Mary’s Hospital  Monday – Friday 9.00am – 4.00pm:email:  dgn-tr.qmh-radiology@nhs.net     

Information on GP referral procedure to the Radiology Department at Darent Valley Hospital

The legal responsibility of the GP as the Referrer is to provide sufficient clinical details in order for the practitioner to justify whether an examination can proceed or not. This is requirement of regulation 4 of the Ionising Radiation (Medical Exposures) Regulations 2017.

As a referrer, you must ensure:-

• The correct patient is referred by ensuring the patient’s identification details are accurate.
• Sufficient legible clinical information is provided to enable the request to be justified (abbreviations should not be used). This must include the background information regarding clinical state and the condition/pathology about which information is sought (e.g. query fracture)
• Appropriate referral criteria are followed. See https://www.irefer.org.uk/
• Abbreviations should not be used.
• Contraindications to the imaging procedure have been considered
• Any additional information or particular requirements are given that would help with the imaging examination which the referrer deems appropriate including specific needs to be addressed e.g. disability, cultural/religious, patient is pregnant. 
• Your name and contact details are correct as it is a legal requirement that referrers are correctly identified. In addition the imaging department may need to contact the referrer urgently with critical or urgent unexpected findings. 
• E-signatures are accepted

dgn-TR.radiologydvh@nhs.net

• That referrals must be made on the appropriate Trust referral form and be emailed to the following email address; 
• If the referral is urgent, it must be clearly marked on the request form.

Referrals which do not meet justification criteria or which contain inadequate/illegible information will be declined. The referrer will be informed of this decision either verbally by phone or by email. 

Dose and Risk information for x-ray and CT examinations can be accessed at https://www.cqc.org.uk/guidance-providers/ionising-radiation/ionising-radiation-medical-exposure-regulations-irmer

The Referrers pause and check poster can also be accessed https://www.sor.org/sites/default/files/pause_check_irmer_referrers_a4.pdf

Information to be returned to the Trust as part of the IR(ME)R audit process.

Please provide names and GMC numbers of all GPs at this practice