Rego advice and guidance

Why are we introducing a new digital platform to manage GP specialist advice requests, and hospital referrals?

As part of a wider programme of work to develop more joined up and consistent ways of working as we move to become an integrated care system, we want to improve the whole hospital referral process. This includes developing and digitising shared processes that connect with our existing digital systems and better meet user needs.

We want to begin this development by moving to a consistent digital approach – using a platform called Rego - to provide GPs with specialist advice and to provide hospital teams with a single system for all advice requests and referrals.

Currently GPs access specialist advice and guidance about potential hospital referrals through a myriad of formal and informal email addresses and telephone numbers, as well as the national e-referral system.

Most channels tend to be standalone, and do not provide any auditable data, and, in most cases, they are disconnected from core patient administration or referral systems and run in the absence of agreed and consistent processes or response times.

In addition, our hospital teams use a range of different processes to vet and triage referrals – depending on where and how a referral originates. All of this can mean additional work and time wasted for GPs and hospital clinicians as well as delays for patients in getting access to the most appropriate care.

When the new platform is fully implemented, it will provide hospital teams with a single, more reliable, and time-efficient route for managing GP advice requests and all referrals. Similarly, it will provide GPs with a single, more reliable, and time-efficient route to specialist advice, and it also has the potential to support further alignment and integration of referral management processes in the future.

When will we be implementing the platform, and who will this impact?

We are implementing across all GP practices in NW London and at Imperial College Healthcare NHS Trust and Chelsea and Westminster NHS Foundation Trust an integrated digital platform – called Rego from May 2022.

The platform will align to what is in use at Hillingdon Hospitals and London North West University Healthcare.

Once it is working effectively, we will close the existing telephone and email advice services at these trusts.

Will the digital platform Rego be used by all North West London Trusts and GP practices?

Yes. A version of the platform is already being used at Hillingdon Hospitals and London North West University Healthcare, and GP practices in Brent, Ealing, Harrow, and Hillingdon.

In May, all GPs and Imperial College Healthcare and Chelsea and Westminster hospitals will be using the platform.

The version of Rego which will be implemented at Imperial College Healthcare and Chelsea and Westminster hospitals will integrate with NHS eRS and patient record systems – to provide more benefits and improve user experience.

The version of Rego used by Hillingdon Hospitals and London North West University Healthcare does not currently integrate with NHS e-Referral, but these hospitals plan to move onto the newest implementation soon, and will provide local communications when plans are finalised.

How will the different implementations impact users?

Clinical and administrative staff at Imperial College Healthcare and Chelsea and Westminster Hospitals

Imperial College Healthcare and Chelsea and Westminster hospitals have implemented Rego with integration with NHS e-Referral and both hospital and GP clinical record systems.

This means both advice and guidance requests and referrals, submitted by GPs through either NHS e-Referral or Rego, will appear in Rego worklists. This helps to avoid risk of double entry, duplication of work and reduce manual input.

All advice and guidance records are automatically uploaded to both hospital and GP clinical record systems. This means clinicians, when receiving a patient referral, can easily check whether the patient has any previous or new advice requests submissions, and be able to review the outcome of these, prior to accepting the referral.

Clinicians can also convert an advice and guidance request into a referral, if the GP has pre-authorised consent for the clinician to do so, without having to go back to the GP, to ask them to resubmit.

The integration does mean staff are required to use a smartcard to access Rego.

For non-ERS referrals, administrative staff will need to download, or extract the referral, usually from an email, and upload into Rego, so that clinical staff can process these in the same way as all other referrals.

Clinical and administrative staff at Hillingdon Hospitals and London North West University Healthcare

At Hillingdon Hospitals and London North West University Healthcare, the process is slightly different, they have been using Rego since summer 2020, however their version does not yet integrate with NHS eRs or clinical record systems.

This means only advice and guidance requests that have been initiated by a GP in Rego, will automatically appear in hospital Rego worklists. Advice and guidance requests initiated in NHS eRS, must be triaged by clinicians in NHS eRS.

In addition, advice and guidance requests cannot be converted automatically into referrals by clinicians. Administrative staff at these hospitals need to manually convert the advice requests into referrals or the clinician must provide advice back to the GP and recommend that they refer the patient using the regular process, while attaching the advice and guidance request and response.

Administration staff at both hospitals need to manually upload finalised advice and guidance requests to the patient record.

At London North West University Healthcare, a manual process has been put in place to upload referrals into Rego – so that clinicians can triage both referrals and advice and guidance requests within one platform, and so they are also able to transfer the request to a different service, within Rego, if needed. At Hillingdon, all referrals need to be triaged in NHS e-Referral. And non-ERS referrals are still managed manually at both Trusts.

Clinicians at both Hillingdon Hospitals and London North West University Healthcare do not need to use a Smart card to access Rego.

When Hillingdon Hospitals and London North West University Healthcare, onboard the newest version of Rego, with integration, clinicians will be able to follow the same process as described above.

What does this mean for GPs when requesting/referring to each of the four Trusts?

GPs can initiate advice and guidance requests using Rego, when contacting all four Trusts.

For GPs contacting Hillingdon Hospitals, advice and guidance must be requested prior to making a referral (excluding 2WW and rapid access pathways)

For all other Trust’s the GP can choose the most appropriate request – either advice and guidance or a referral through eRS All referrals will be reviewed and advice provided wherever this is appropriate.

GPs will be able to pre-authorise the conversion of advice requests into a referral when they use Rego to initiate an advice request with either Chelsea and Westminster and Imperial College Healthcare. The hospital clinician will be able to automatically convert a request for advice into a referral, should this be clinically appropriate. It is important that patients are aware that this may happen and that any discussions about hospital preferences are documented in the advice request.

If a GP sends an advice and guidance request to either Hillingdon Hospitals or London North West University Healthcare and a decision is made that a referral is required, the GP will need to follow the existing referral process and initiate the request in NHS eRS.

When Hillingdon Hospitals and London North West University Healthcare, onboard the newest version of Rego, with integration, GPs will be able to follow the same process as described above.

If a GP needs specialist advice or guidance to help inform a hospital referral decision, they will initiate a request through the Rego platform, which will already have been installed on their PC.
 

The platform will automatically attach key patient demographic information equivalent to what is required within the standard hospital referral letter templates. Active, past medical history, along with medication, investigations (past 12 months) and family history is added. The GP can also attach any additional information they feel is relevant, including good quality images.

The GP can pre-authorise the conversion of the advice request into a referral, if needed. Please note: the GP must pre- authorise to enable the hospital clinician to automatically convert the request into a referral. If the GP does not provide consent, the hospital clinician can only advise the GP to refer the patient on eRS.
The request will be sent to the most appropriate worklist at the relevant Trust where a hospital specialist will review the information and choose one of the following options:

• request further information 
• provide advice and guidance to help the GP to support the patient directly
• refer the patient into the hospital service

If a patient needs a hospital referral (and the GP has pre-authorised), the specialist will be able to progress it within the Rego system by sending the request directly to the hospital appointment booking team or, if the service offers a ‘choose and book’ option, there will be a facility for the patient to action the referral themselves.

How long will a GP need to wait to receive a response to an advice request?

The hospital specialist should submit a response through Rego within three working days of the request being submitted.

The new platform offers a reporting dashboard which will be used to monitor and expedite any requests that exceed the three-day timeframe. Depending on individual requests, the Trust may contact the GP to explain why there is a delay, and when they can expect to receive a response.

Can a GP attach the patient’s medical history including past diagnostic test results, within an advice request?

Yes, as part of the new process, GPs should ensure key information is downloaded from SystmOne and combined within one PDF document attachment, alongside the advice and guidance request.

The information will include:

• key patient demographic information equivalent to what is required within standard referral letter templates
• active and past medical history
• current and repeat medication
• any investigations within the past 12 months
• family health history
• any recent GP consultations.

The GP can also attach high quality images and any other relevant information.

Can GPs submit advice requests to specific consultants?

No, GPs can only submit advice and guidance requests to specialties, for example Cardiology or Urology. The requests will be added to the specialty worklist. All consultants assigned to the worklist will be able to see all request cases.

Each specialty might manage advice request triage differently, some specialties may have clinical nurse specialists, registrars and/or consultants monitoring the worklists.

What is the process when a hospital specialist requires further information?

On occasions a hospital specialist may require further information from a GP before deciding what would be best for a patient. When this happens, the hospital specialist will respond to the GP, and initiate a conversation trail, associated with the initial request.

The GP will be able to respond with additional information, and the follow-up message will be added back into the specialty worklist.

This means any specialist could pick up the response and decide the best next steps for the patient. However, the platform does label which specialist originally responded and requested the additional information, which means speciality teams can choose to leave requests for a specific specialist, assuming they are not absent or on annual leave.

What is the process when a hospital specialist would like the patient to be referred to hospital?

The hospital specialist can directly convert an advice and guidance request into a referral, if the GP has preauthorised the option to refer the patient, when initiating the advice and guidance request. The GP will be notified of this action.

The referral will be passed to the hospitals administration team, into the ‘to be booked list’ on e-RS, and an appointment will be booked for the patient.

Who owns clinical responsibility for a patient, when a GP is waiting for a response to an advice request or for a referral to be triaged?

The clinical responsibility for a patient sits with a GP until the referral is accepted by a hospital clinician.

A GP does not have to accept advice provided if they feel it is not right for the patient and, if required, they can still refer a patient using NHS e-Referral.

Will the patient be able to see the response to an advice and guidance request, and will they be directly notified?

No, the patient will not see the response from the hospital clinician. It is the GPs responsibility to feedback any advice provided by the hospital clinician, to the patient.

However, if a patient requests a copy of their clinical record from their GP practice or hospital, all advice and guidance requests and responses will be included.

We are also developing a patient leaflet, which GPs can use to help explain the advice and guidance process to patients.

Can clinical professionals such as dentists and opticians use Rego to request advice and guidance?

Currently the Rego platform can only be accessed by GPs.

However, tertiary referrals - including those made by other clinical professionals including opticians or dentists, and clinicians at other NHS Trusts, will be pulled into Rego, so that hospital clinicians can triage all advice requests within one platform.

Will the NHS e-Referral system and any existing advice and guidance shared emails and telephone numbers be switched off when Rego is up and running?

NHS e-Referral will not be switched off, however it should no longer be used by North West London sector GPs and Hospital specialties to request or triage advice and guidance requests.

However, GPs outside of the North West London sector, will still be able to request advice and guidance through NHS e-Referral, through integration these requests will appear in Rego. This means hospital specialists will only need to check Rego for all advice and guidance requests.

Advice and guidance email addresses, and telephone numbers should be closed, and an out of office message should be added, directing GPs to request advice and guidance through Rego.

If an advice and guidance mailbox or telephone number is also used for other purposes, a different out of office message should be added, explaining that advice and guidance should be requested through Rego, but also provide an explanation on what the email address or telephone number can still be used for.

We will provide recommended content for out of office messages.

GPs will still be able to make referrals directly via the NHS e-referral system where they are clear on the referral guidance.

2WW referral pathways remain unchanged and should be made using the appropriate 2WW forms on eRS.

All referrals – from all routes - will then appear in a separate Rego worklist, so they can be vetted and triaged within one platform.

The clinician will then review the information that has been provided within the referral and either:

• • request further information 
  • provide advice and guidance to help the GP to support the patient directly
  • accept the referral

Referrals that are received outside of eRS will be manually uploaded by a member of the administration team to Rego, and the clinician will then be able to follow the same process.

Can hospital clinicians provide advice in response to a referral in Rego?

Yes, hospital clinicians can provide advice back to a GP on a referral and are encouraged to do so when clinically appropriate.

When a patient is referred, will I be able to review if they have already been issued with advice and recommended actions, prior to responding?

Yes, you will be able to see any previous advice and guidance requests and responses, which will be saved in the patient’s record in our clinical document library (CDL). You can check this information before yourespond to the new referral or advice request.

Will the new digital platform, Rego, integrate with Cerner? If so, when a referral is received, or an advice and guidance request is converted into a referral, will an encounter be created on Cerner and subsequently a diagnostic test can then be requested?

In addition, can investigations and pre-clinic tests be requested through Rego if a referral is accepted, or an advice and guidance request is converted to a referral?

No, an encounter is not created within Cerner when a request/referral is triaged, however the Rego transaction is saved in CDL at Imperial College Healthcare and Evolve at Chelsea and Westminster, which is accessible from Cerner.

The referral letter and the output of your advice and guidance will populate on CDL/Evolve respectively.

The ambition is to provide this integration in the future to allow an encounter to be created.

Will I receive training so that I know how to use the new platform, to triage both advice and guidance requests and referrals?

Yes, training can be accessed through your e-learning portal, and you can find further information on your intranet.

• Information for Imperial College Healthcare colleagues
• Information for Chelsea and Westminster colleagues

What should I do if I have a problem with the system, or I need to change the setup of Rego for my specialty?

During the first couple of weeks, a Microsoft Teams chat link will be created where you can submit any issues that you might have with the new system. The project team will then advise on next steps and aim to respond within 3 hours. For issues with the system going forward, Imperial users, please contact your ICT helpdesk team for support. For Chelsea and Westminster users, please complete a contact form available on the intranet and send it to your service manager.

How will we manage provision of advice and guidance?

All advice and guidance activity through Rego, should replace any advice and guidance activity provided through NHS e-Referral, email, or telephone, and any unnecessary referral triage which is being carried out.

In the longer term, by formally recording and reporting activity on Rego, we plan to suggest to our commissioners that advice and guidance becomes a funded activity.

Will I be notified by email when an advice request, or a referral is added to my specialty's worklist?

No, hospital specialists will not receive notifications when requests are awaiting review and advice.

We recommend that you set time to review requests, while you review referrals.

If you would like administrative team members to review your Rego worklist, you can request that they have read only access to the platform by contacting your ICT service desk.

How can I access the Rego platform?

Rego will be automatically installed onto GP’s computers.

Once Rego has been installed, the GP will be able to launch Rego from within their clinical system, through clicking the button pictured in the training video.

Rego will launch online, through either Internet Explorer or Edge web browser, and will display an online form which will capture the patient’s demographics and full medical history. This includes medication, medical conditions and tests/investigations carried out with the last year.

Will I receive training on how to use Rego?

The Rego team held several sessions earlier in the year. In addition, there will be a further training session held prior to launch - details will be sent soon.

There will also be training videos and training guides for those who cannot make sessions and can be used as a reference point once the system is live.

What should I do if I have any issues or problems with Rego?

Rego have an established and dedicated support desk.

When using the system there is a live chat function built into all elements to allow direct communication with the support team from Monday to –Friday, 9am to 5pm when a support team member is available.

There is also a support form: https://vantage.health/support and a support phone line 0207 993 5870

Will I be able to access the Rego platform from home?

Yes, you will be able to access Rego from home if your NHS device has remote access to a secure NHS network and you have a smart card with reader.

Which internet browsers do you require to access Rego?

Rego can be accessed through either Internet explorer or Microsoft Edge.

Will Rego produce data reports on all advice and guidance activity?

Yes, the digital platform Rego has a comprehensive reporting dashboard that provides access to live activity data, key performance indicators and statistics.

Data can be presented in a variety of formats, so that we can accurately monitor performance by specialty and clinical pathway. We can also review the volume of requests that have been triaged, by whom as well as the time it takes to triage requests.

The data will help us to identify areas for improvement and inform future developments, and training.

All reports can be exported into Excel or a CSV file, we are working with BI teams to also provide a report via the QLikView Portal for direct access to relevant data.

The data can be accessed by general managers, patient access and BI teams.