Neurosurgical Referrals - General DRAFT

Overview

The information on this page has been produced in partnership with James Pendle, Olivier Sluijters and Adam Williams at NBT.

The neurosurgical department at NBT is a tertiary referral unit and therefore does not usually accept routine referrals directly from GPs. However, there is access to certain neurosurgery clinics via eRS and these are described in the directory of services. Please note that many of these clinics are Triage or Referral Assessment Services (RAS) so referrals may be returned to referrer if not appropriate.

Patients for other neurosurgical procedures will normally be referred from other secondary care specialties or MSK Interface Service.

Emergencies - Patients with suspected cranial or spinal trauma should usually be referred to the local Emergency Department for imaging prior to onward referral if necessary. In BNSSG the options are:

• Bristol Royal Infirmary
• Southmead
• Weston-super-mare (0800 to 2200)

Post Operative Concerns - If you have acute concerns about a patient who has recently had a neurosurgical procedure and you require a same-day response, please refer urgently to the on-call team via Refer-a-Patient (see below). If you do not require same day advice, please contact the patient’s surgical team. These details should be available on their recent clinic / discharge letters.

Referral

The referral pathway options for neurosurgical services from primary care are as follows:

• Brain and CNS – USC (2WW)  - for patients with suspected cancer.
• Referapatient - this is the on-call team and is monitored 24/7 by the on-call registrar for adult neurosurgical care for Gloucestershire, Somerset and Wiltshire and the city of Bristol. - see the section below for instructions on how to use this referral route. If you are referring an emergency that requires immediate attention, please also call the on-call phone (0117 414 5726).
• ERS (Triage/RAS)- these referrals are triaged by the neurosurgery secretaries / advanced nurse practitioners and directed to the appropriate consultant team. Please note that there is no routine Advice and Guidance service on eRS for neurosurgery. 
• Multi Disciplinary Team Meetings (MDTs) - there are several subspecialty MDTs that meet on a weekly or monthly basis, where complex and/or semi-urgent cases can be discussed. Please go to Signpost | Neurosurgery MDT | North Bristol NHS Trust page which will give advice on how refer to the appropriate MDT via Referapatient. (Is this the correct route for GPs?)

Please visit the Neurosurgery Remedy pages within the for the relevant condition for information and guidance on pathways.

Referapatient

Acute Referrals

For acute, on the day neurosurgical advice please go to the following referral website:

• Referapatient Homepage

Please see the following tips on how to use this platform:

• You do not need to log in to use the site so ignore this box.
• For acute referrals choose option 1 - 'Refer a patient or ask advice from a specialist (new episode)'.
• The hospital/service provider is Southmead Hospital - North Bristol NHS Trust.
• The speciality is Neurosurgery (referapatient is used by other providers across the country but only by neurosurgery and vascular teams in BNSSG).
• You will then be taken to a screen with further details on how to complete the referral process.
• Making a referral can take a few minutes so patience is needed.
• The site does not automatically upload information from EMIS so patient, clinical and referrer details need to be free-texted in the boxes provided.
• This site is secure and meets all data protection requirements so full patient details can be included i.e full name rather than initials.

Further details on how to use the site can be found here.

MDT Referrals

MDT Referrals can be made via Referapatient as well via the following page:

• Neurosurgery MDT | North Bristol NHS Trust

This page links to the following MDT referral pathways:

• Neuro-oncology MDT
• Skullbase MDT
• Neurovascular MDT

Resources

Links to NBT Services

Neurosurgery

Bristol Neuro-oncology Group

Neurosurgery MDT Referral to Multidisciplinary Team Meetings (MDT) at North Bristol Trust

Neuro-oncology (BNOG) Referrals

Head Injury Therapy Unit (HITU) On-call referrals: https://www.referapatient.org/refer-a-patient 

GIRFT guidance: Spinal – Suspected Cauda Equina Syndrome 2a - GIRFT - Pathways 

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.