TRAQS - NHS Shropshire, Telford and Wrekin

Supporting information for referral processes with TRAQS can be found on the following section.

NHS Shropshire, Telford and Wrekin CCG works collaboratively with health professionals, building relationships with clinical and managerial colleagues to develop and deliver the very best care for patients.

Help and Assistance

You are able to contact TRAQS in any one of the following ways:

TRAQS Practice Support Line: 01952 580367

Email: traqsteam@nhs.net

TRAQS
NHS Shropshire, Telford and Wrekin CCG
Halesfield 6
TF7 4BF

For any clinical issues, either within TRAQS or the CCG, please contact Dr Andy Inglis on 01952 580300 or andy.inglis@nhs.net.

If you are experiencing any issues with TRAQS, want to make a suggestion or seek clarification on anything, please feel free to contact Kelly Lawrence on kelly.lawrence2@nhs.net.

Are you a GP who is new to NHS Shropshire, Telford and Wrekin CCG?

TRAQS have produced an information document for GP practices to help guide you through the process of creating referrals within Telford and Wrekin CCG.

Ideal referral letter content

TRAQS have produced some guideline based on NICE guidance detailing what we would recommend as the contents for an ideal referral letter.

Creating a referral in EMIS using ICG and sending on to TRAQS

The following document guides you through the step-by-step process of creating a referral in your EMIS Web System and sending it across to TRAQS for processing.

Please note that in most practices within the CCG it will be the practice secretaries who will complete this task on your behalf.

Consultant to Consultant Referrals Policy

In order to ensure that all Consultants in SaTH manage consultant to consultant referrals in a consistent way, the CCG has introduced a new Consultant to Consultant policy.

What happens when a referral reaches TRAQS?

In order to allow TRAQS to process referrals in an efficient and timely manner, we need the following information added to the ICG referral:

Up-to-date demographics (including daytime contact number);
Primary reason for referral including clear referral instructions and duration of symptoms;
BMI/BP taken within the past 12 months (supports VBC, private Care Pathways);
Previous medical history and any recent investigations;
Current medications, if applicable;
Please include any clinic letters that may be detriment to the referral (if a patient has been seen by a service previously, including the last clinic letter will support if they choose to go to an alternative provider who would reject without).

TRAQS review all referrals and if it is felt additional information should be supplied to support the referral; the practice secretaries will receive communications. This includes information in regards to the VBC policy.

Special Instructions and Admin Notes (ICG Referrals)

Please be aware that the admin note option in the ICG referral document is only visible to TRAQS. If there is specific information you want providers to be aware of, please make sure it is all included in the body of the referral letter.

This should include any accessible information not already evident in the referral (language and physical barriers that may need to be considered).

Referral Pathways NOT through TRAQs:

X-Ray and MRI (paper direct to provider)/Unless requiring consultant lead request (usually children’s pathway);
Mental Health/Excluding Adult ADHD;
GU Medicine;
Obstetrics/Excluding pregnancy related Endocrinology and Physio;
Fracture Clinic (direct to SATH);
Palliative Medicine;
Transgender;
Sexual Health;
Travel Health.

If you are ever unsure on pathways, please feel free to contact TRAQS directly.

Services NOT currently available in Shropshire (SATH):

Adult Allergy;
Neurology;
Neuro-Ophthalmology;
Neurosurgery;
Plastic Surgery;
General Anaesthetic procedures for Cataract and Vasectomy.

TRAQS will offer your patient’s choice of services/appointments where available and in line with any localised restrictions and funding policies. Should you require referral updates, please feel free to contact the team who can check on progress or advise further.

What is NOT available via NHS (VBC/IFR)

The NHS cannot always fund treatments/operations that are not routinely funded by NHS, normally this is because they:

Are not clinically effective or effectiveness has yet to be determined;
Are not cost-effective in comparison to all the competing demands on NHS funding;
Have a low clinical priority and offer little health gain;
Are largely cosmetic in nature.

Sometimes we will consider paying for a treatment or operation that is not normally funded. This happens when:

A patient has a set of circumstances that are very different from anyone else with the same, or a similar, condition. Your health professional will need to explain how you will derive greater benefits from the intervention than others who are in a similar position;
And there is good evidence to suggest that you would be healthier after the treatment or operation.

Referrals should confirm that patient’s fulfil the criteria as outlined in the relevant area of the policy before referring the patient. TRAQS will request additional information if required and seek support from the Medicines Management team for clinical support.

There are some providers that can be very strict in regards to this criteria being met, we appreciate that referrals are required to be processed ASAP. We aim to get the required information and progress as quickly as possible to support your patients.

Value Based Commissioning Policy (VBC)

Please click here for the full VBC policy.

TRAQS are well versed with the majority of VBC policy and should you have any queries, please contact the team who will be happy to support.

TRAQS may ask for additional information to support referrals progressing to the appointment stage and many providers (especially local) can be very strict in regards to criteria.

Ultimately it is a CCG decision if a referral will be funded so having as much information as possible, in line with the VBC policy, supports any treatment going ahead.

Should you require further support with VBC related referrals, please call TRAQS directly or email our dedicated VBC email address: stwccg.eripteam@nhs.net

Individual Funding Requests (IFR)

The CCG explicitly recognise that for each of the interventions listed in this policy there may be exceptional clinical circumstances in which the CCG would consider the funding of these interventions. It is not feasible to consider every possible scenario within this document. In cases where specified criteria are not met, applications may be considered on an individual basis through an Individual Funding Request (IFR) process.

Please click here for Medicines Management – Individual Funding Requests (IFR) for Shropshire, Telford and Wrekin

TRAQS Referring Support Notes to Practices

TRAQS have a vast knowledge available to them about providers and pathways for referrals. If ever a practice is unsure of a pathway or would like additional support, we encourage them to please contact TRAQS and we will be happy to support.

There are some providers that may expect additional information such as a proforma, scans and potentially other pathway evidence to enable them to accept your patient for treatment.

There may also be instances where further criteria is needed to support an NHS funding decision (VBC),we endeavour to support all practices and patients to get referrals to where they are suitable to go as quickly as possible.

Where possible, TRAQS will try to capture common reasons for rejection before the referral progresses to provider, so to avoid any unnecessary letters to patients which can potentially create confusion.

There will of course be an instance where a consultant/specialist may feel additional information is required after the referral is booked, but we will try to support all practices with the knowledge and support available to avoid unnecessary rejections.

Below are some general reminders and support notes for referring via TRAQS. This has not included every speciality. Please contact TRAQS who will happily support.

2WW

Must include a 2WW proforma in ALL instances;
If referring to an out of area service, these too must include a 2WW proforma and in most instances are available on the specific hospital websites. Or contacting their fast track/2WW service directly;
Children pathways for 2WW Breast, Skin and Sarcoma referrals must be completed on an adult proforma;
All other 2WW Children specialities should be discussed with the GP and on call oncologist who will let them know how quickly the patient needs to be seen (this information should be recorded on the proforma if coming via TRAQS).

2WW Breast

The only way to refer into breast clinic is via the 2WW Breast pathway;
Please review the proforma as you can select alternatives to cancer related, but the only way we can send this to the local provider is via 2WW.

Advice and Guidance Request

Where possible TRAQS will always direct this to the most local hospital, or as instructed if for a particular consultant/service.

BMI/BP

It is recommended to include up to date BMI/BP with all referrals where possible (dated within the last 12 months), so to support provider triage once booked.

TRAQS will also request these to support the VBC criteria for some procedures and will request up to date readings if your patient could benefit from treatment with private care providers (quicker than NHS locally for most specialities).

Cardiology

In many referrals, if a patient needs a general consultant appointment, it is recommended by providers (secondary care) that a recent ECG should please be sought in the first instance, please consider before sending referrals;
There is a community service available within the local area which usually has a considerably shorter waiting time (4-5 weeks) than that of secondary care providers (12+weeks). If the referral is not considered an urgent or a complicated cardiology request TRAQS may direct this referral to their pathway (we will offer the choice to your patient).

Children and Adolescent Services

Once a child reaches 16, they are considered an adult under NHS and should be referred through adult services.

This may differ for community based services not through TRAQS (for example mental health);
Children under 6 weeks still fall in line with post-natal for feeding and should be directed to the midwifes or health visitors;
Tongue Tie– Children under 2 years old should be picked up with Health Visitor in the first instance as this is not supported under secondary care in early years.

Diagnostic Imaging

Includes cardiology based testing such as ECG, Echocardiogram, 24/72 hour tape etc., Nerve Conduction Studies;
If unsure, please contact TRAQS and we will confirm;
Open MRI– Open MRI no longer comes via TRAQS, these should be sent directly to Burton Hospital by the practice. There is a form they need to complete and send to admin.radiology@nhs.net.

ENT

Audiology

SATH Proforma– if using the audiology proforma (not a requirement for audiology requests), please note that if markers on the proforma are selected as YES, it needs to include a description of symptoms, else ENT will reject the request. For example ‘Persistent pain affecting either ear (defined as earache lasting more than 7 days in the past 90 days before appointment)’, ‘Sudden or rapid loss or deterioration of hearing (sudden = within 1 week, in which case sent to A&E or Urgent Care ENT clinic, rapid = 90 days or less)’;
Domiciliary hearing assessments do come through TRAQS and are processed to SATH.

Micro Suction and Ear Wax Removal (VBC)

ENT have a very strict process for Micro suction, please always refer to the VBC policy before referring and ensure the referral states why a patient should be seen within secondary care rather than in practice (many reasons such as perforated ear drums, previous surgery and others);
Unless you practice categorically do not offer an irrigation service (confirmed with CCG commissioning), then irrigation should always be attempted within primary care first. This must be evidenced (a sentence) if it has been attempted within the referral letter.

Tonsillectomy (VBC)

ENT has a very strict process for Tonsillectomy, please always refer to the VBC policy before referring your patient;
Referrals must clearly evidence how the patient meets criteria and will be returned by TRAQS if we need additional information.

Gynaecology

Where appropriate referrals will be directed to the community gynaecology team (managed by PRH), who will triage and contact the patient in regards to a suitable location/appointment.

Infertility

Must include proforma, which should include the partners details;
If either of the couple has children from current/previous relationships, NHS will not fund treatment or investigations;
Must include patients up to date BMI;
If patient has had previous IVF support, this will not be funded again via NHS.

Marina Coil (VBC)

Coil removal should always be attempted within primary care first. This must be evidenced (a sentence) if it has been attempted within the referral.

Neurology

NOT AVAILABLE IN SHROPSHIRE

Currently there is no pathway available within Shropshire;
Please ensure any previous clinic letters are provided with all referrals if your patient needs a new review;
Many out of area neurology departments will request scans to be included with referrals, please ensure all relevant information is available when submitting the referral.

Occupational Therapy

Home adaptions– if a patient has a TF postcode TRAQS direct this through to the local Access team via T&W council;
If your patient lives out of area (Shropshire, Stafford etc.) you would need to direct this referral to their local council. Basically it’s to whom they pay their council tax.

Ophthalmology

24 Hour Treatment

If an opticians sends a requests that states they need treatment/review within 24 hours, please send direct to the SATH Ophthalmology Service(Humming Bird Centre, please call direct to confirm process).

General Ophthalmology

GOS18’s could be provided with all referrals. Exceptions to this may be for Chalazia/lesions removal;
In most instances, patients would have been seen by local opticians before referral.

Cataract

Referrals will be rejected is missing GOS18 detailing Visual Acuity;
BMI/BP readings: There are several options for private provider treatment and this is required to assess suitability.

WET ARMS / AMD

These preferably should be sent direct to SATH/SATH Ophthalmology Service (Humming Bird Centre);
TRAQS will process if received to avoid delay in patient care.

Pears Testing

Please send direct to hospital.

Orthopaedics – MSK and Podiatry

The majority of these types of referrals will likely be seen in the local community team in the first instance;
TeMS The services require completed proforma with all referrals and will be rejected without.

Diabetic Foot Screening

Any Low Risk Diabetic Foot Screening should be carried out within the medical practices;
The Diabetic Foot Screening service will now only see patients who are deemed High or Moderate Risk (please detail in referral).

Verrucas

There is no pathway through TRAQS for podiatry or dermatology, however the Shropshire Podiatryservice will offer advice to patients treat and can be contacted on 01743 277 681

Respiratory

Long Covid Clinic

Referrals come via TRAQS and are sent to the community Respiratory Nurses via SPR. ALL referrals must include a Decision Tool form which can be obtained from SPR directly (TRAQS can provide a copy).

Pulmonary Rehab

No longer through TRAQS/a direct referral from the GP. They have a new email and number, and if practices call asking how to process these referrals they will need to email the proformas to pulmonaryrehab@nhs.net, contact number – 01743 730034,
Long Covid Referrals– these do come through TRAQS and are directed through to the Single Point Team (SPR), who will refer onto secondary care if required.

Surgery

Hernia (VBC)

BMI/BP readings, several options for private provider support available and this is needed to review suitability.

Hernia Corset/TRUSS

Requests for a hernia corset/truss, the pathway is not through TRAQS and these should be directed via a prescription to the pharmacies;
Medical practices should be sending a script that confirms diagnosis of hernia, where it is, size and weather it is reducible;
There are a numbers of TRUSS available on the prescription system and if practices are still unsure what type is needed, they should then consider an A&G request and not a referral, as this is not suitable for an appointment.

Wheelchairs / Mobility Assessments

Adults– Go via Singlepoint through TRAQS (including electrical);
Children– NOT VIA TRAQS/Practices would have to have a Wheelchair & Posture Referral form completing. This can only be completed by an accredited user, who will have completed a training course directly with them. Persons who can support would be as follows: School Nurse, Senco, Members of Children’s Services, some Physio’s and OT.