Specialist Service Referrals
Two week wait referral forms
All two week wait referrals must include the appropriate pro-forma as an attachment.
The pro-forma contains the appropriate clinical information, reason for referral (letter text) and a section for basic patient information (name, date of birth, NHS number and NHS e-Referrals UBRN). This should be sent together with the practice's standard referral letter, which will contain full patient demographic information, practice details and items from the patient's medical record if this has been set up. Both documents must be attached at the same time.
It is recommended that these pro-formas be downloaded and saved in an appropriate folder on your clinical server so that they can be used by all users within the practice.
Find a list below of the relevant two-week wait referral forms:
Download and read the two-week wait patient information leaflet
Below is a list of our specialties and how to refer to them. For other services please contact the service directly or refer to our Treatment Pathways.
Cardiac Rehabilitation at The Alexandra Hospital
Please contact the Cardiac Rehabilitation team at either Worcester Royal or Kidderminster Hospital and Treatment Centre. Please remember to include the patient's name, address, date of birth, contact number and medical history, especially in relation to cardiac history.
This service accepts patients with:
- Angina+ PCI NSTEMI/STEMI +/- PCI
- Post CABG
- Post Valve surgery+CABG
- Patients with stable heart failure
Please also let us know if the patient has any know mobility or balance problems.
Cardiology rapid access referral
Worcestershire Acute Hospitals NHS Trust has established a new Rapid access Heart Failure service, this service is intended for de novo suspected heart failure.
Patients with a previous history of heart failure will not be accepted and please refer to general cardiology OPC
Patients on the urgent pathway will have echocardiograms on the day the rapid access heart failure clinics appointment.
Patients on the routine pathway will have echocardiograms prior to the rapid access heart failure clinics appointment.
For all patients with suspected heart failure and a positive NTproBNP (particularly when very high) please consider starting treatment with a loop diuretic immediately. NTproBNP is very sensitive but not very specific-i.e. identifies possible heart failure but does not confirm a diagnosis. Other causes of raised NTproBNP include: AF, severe lung disease, age>70, and renal impairment amongst others.
Please do not use this pathway for:
- Access to the heart failure nurses (refer directly to the community teams for patients with known heart failure and reduced ejection fraction),
- Patients who cannot attend hospital appointments,
- Patients with severe competing comorbidity such that further investigation and specialist management of their heart failure are unlikely to improve quality of life or other outcomes.
- For patients with uncontrolled AF and no overt fluid overload (raised JVP, oedema) please consider rate control before checking NTproBNP. If the patient remains symptomatic with possible heart failure after rate control then check NTproBNP and refer as usual. If minimally symptomatic at that stage consider community echo and/or general cardiology referral.
Dermatology
Worcestershire Acute Hospitals NHS Trust have established a new Dermatology service for patients in Worcestershire provided by both us and a new community provider, DMC Healthcare Limited (DMC).
DMC already provide Dermatology services to patients in the north of the county and will now be providing a countywide community service. We will continue to provide countywide specialist Dermatology services. Patients who meet the eligibility criteria should be referred by e-Referral.
Diabetes
Our diabetes service is run in outpatient clinics by our Diabetes Specialist Nurse team who work closely with the consultant diabetes team and Community Diabetes Specialist Nurses. We offer structured patient education courses more information about how to make a specialist referal by completing the form below:
document
DAFNE (Dose Adjustment For Normal Eating) referral form
(30 KB)
pdf
DAFNE information leaflet
(198 KB)
pdf
X-PERT Diabetes First Steps - programme information
(180 KB)
document
X-PERT Diabetes referral form
(445 KB)
Suitable for new or recently diagnosed type 2 diabetes
document
X-PERT Diabetes information leaflet
(30 KB)
document
X-PERT Insulin referral form
(445 KB)
Suitable for people with type 1 or type 2 diabetes treated with insulin
pdf
X-PERT Insulin information leaflet
(190 KB)
Dietetic adult service referral
Please complete the
document
Dietetic referral form
(16 KB)
and send to Janet Mole, Dietitians' secretary at the Alexandra Hospital, Redditch.
Early Inflammatory Arthritis Clinic
An early inflammatory arthritis (EIA) clinic has been established at Worcestershire Acute Hospitals NHS Trust to rapidly assess, and if appropriate, start treatment for patients with suspected inflammatory arthritis.
From 20 April 2017 patients will be able to be referred directly via the NHS eReferral Service. The clinic is for patients with new onset persistent suspected synovitis and patients will be seen within three weeks of referral.
Patients who meet the eligibility criteria should be referred by eReferral with a completed EIA referral form (referrals received without an accompanying form will be rejected and returned).
document
Early Inflammatory Arthritis referral form
(211 KB)
ENT
In order to request funding for a Tonsillectomy eligible patients should have the below referral proforma completed and attached to their referral letter.
- GP to Specialist Referral Proforma Tonsillectomy
- CCG Tonsillectomy Commissioning Policy
General Surgery
GP to Specialist referral proforma Hernia
The 3 Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link:
http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
GP to Specialist referral proforma Gallstone Disease and Gallbladder Pathology
Home Oxygen Service
Please complete the HOS-AR referral form and email to This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01905 681062.
Lung Cancer Service
Please complete this urgent referral for
document
suspected lung cancer form
(93 KB)
. An accompanying referral letter is required for all patients.
On completion please fax to the Cancer Referral Centre 01562 754312 or 01562 513021.
This form should only be used for suspected cancer and in conjunction with the NICE Referral Guidelines for Suspected Cancer, June 2005.
Maternity
We are happy to continue to accept new booking referrals for our maternity services. These can be sent to either the Alexandra Hospital or Worcestershire Royal Hospital, as is current practice, for delivery on the Worcestershire Royal site.
The antenatal clinics and booking process remain the same and the different venues for booking appointments across the county will continue.
During the antenatal period, the midwife will continual assess and offer the appropriate choices for place of birth (home, Meadow Birth Centre or consultant-led Delivery Suite at Worcestershire Royal).
Neurophysiology
Referrals can be made using our Neurophysiology referral form or by sending a traditional letter to the department. All clinical information must be included and appointments will be made based on this information.
Paediatric Phlebotomy Service
Phlebotomy appointment service for under 18’s are held at a speclialiust children's clinic at the Alexandra Hospital, Redditch. Please note appointments are only available on certain days at certain times – we do not offer a ‘drop in’ service.
Direct dial number – 01527 512758
We will need a request on ICE if available or paper forms can be given to parents/carers.
Parents can telephone clinic to make appointment once request has been arranged.
The information we will need:
- Child’s name
- NHS number
- Address
- Phone number
- Date of birth
- Name of GP
Pathology
We provide high quality evidence-based cellular pathology, clinical biochemistry, haematology and blood transfusion and microbiology services from laboratories at the Alexandra, Kidderminster and Worcestershire Royal hospitals.
We also provide pathology services for the Worcestershire Health and Care Trust and Worcestershire’s three Clinical Commissioning Groups as well as other healthcare organisations in the county.
To find out more information about our pathology service and how to provide samples, please read our guidelines.
Speciality of Gynaecology
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
Speciality of Orthopaedics
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
- GP to Specialist Referral Proforma - Hip & Knee
- GP to Specialist Referral Proforma - Carpal Tunnel
- GP to Specialist Referral Proforma Symptomatic Knee Pain Non-Traumatic
- Musculoskeletal Surgery and Therapeutic Interventions Commissioning Policy
Speciality of Urology
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
Vascular
All patient referrals for the Vascular Varicose Vein service must be accompanied with a referral proforma to be considered for surgery.
Cardiac Rehabilitation at The Alexandra Hospital
Please contact the Cardiac Rehabilitation team at either Worcester Royal or Kidderminster Hospital and Treatment Centre. Please remember to include the patient's name, address, date of birth, contact number and medical history, especially in relation to cardiac history.
This service accepts patients with:
- Angina+ PCI NSTEMI/STEMI +/- PCI
- Post CABG
- Post Valve surgery+CABG
- Patients with stable heart failure
Please also let us know if the patient has any know mobility or balance problems.
Cardiology rapid access referral
Worcestershire Acute Hospitals NHS Trust has established a new Rapid access Heart Failure service, this service is intended for de novo suspected heart failure.
Patients with a previous history of heart failure will not be accepted and please refer to general cardiology OPC
Patients on the urgent pathway will have echocardiograms on the day the rapid access heart failure clinics appointment.
Patients on the routine pathway will have echocardiograms prior to the rapid access heart failure clinics appointment.
For all patients with suspected heart failure and a positive NTproBNP (particularly when very high) please consider starting treatment with a loop diuretic immediately. NTproBNP is very sensitive but not very specific-i.e. identifies possible heart failure but does not confirm a diagnosis. Other causes of raised NTproBNP include: AF, severe lung disease, age>70, and renal impairment amongst others.
Please do not use this pathway for:
- Access to the heart failure nurses (refer directly to the community teams for patients with known heart failure and reduced ejection fraction),
- Patients who cannot attend hospital appointments,
- Patients with severe competing comorbidity such that further investigation and specialist management of their heart failure are unlikely to improve quality of life or other outcomes.
- For patients with uncontrolled AF and no overt fluid overload (raised JVP, oedema) please consider rate control before checking NTproBNP. If the patient remains symptomatic with possible heart failure after rate control then check NTproBNP and refer as usual. If minimally symptomatic at that stage consider community echo and/or general cardiology referral.
Dermatology
Worcestershire Acute Hospitals NHS Trust have established a new Dermatology service for patients in Worcestershire provided by both us and a new community provider, DMC Healthcare Limited (DMC).
DMC already provide Dermatology services to patients in the north of the county and will now be providing a countywide community service. We will continue to provide countywide specialist Dermatology services. Patients who meet the eligibility criteria should be referred by e-Referral.
Diabetes
Our diabetes service is run in outpatient clinics by our Diabetes Specialist Nurse team who work closely with the consultant diabetes team and Community Diabetes Specialist Nurses. We offer structured patient education courses more information about how to make a specialist referal by completing the form below:
document
DAFNE (Dose Adjustment For Normal Eating) referral form
(30 KB)
pdf
DAFNE information leaflet
(198 KB)
pdf
X-PERT Diabetes First Steps - programme information
(180 KB)
document
X-PERT Diabetes referral form
(445 KB)
Suitable for new or recently diagnosed type 2 diabetes
document
X-PERT Diabetes information leaflet
(30 KB)
document
X-PERT Insulin referral form
(445 KB)
Suitable for people with type 1 or type 2 diabetes treated with insulin
pdf
X-PERT Insulin information leaflet
(190 KB)
Dietetic adult service referral
Please complete the document Dietetic referral form (16 KB) and send to Janet Mole, Dietitians' secretary at the Alexandra Hospital, Redditch.
Early Inflammatory Arthritis Clinic
An early inflammatory arthritis (EIA) clinic has been established at Worcestershire Acute Hospitals NHS Trust to rapidly assess, and if appropriate, start treatment for patients with suspected inflammatory arthritis.
From 20 April 2017 patients will be able to be referred directly via the NHS eReferral Service. The clinic is for patients with new onset persistent suspected synovitis and patients will be seen within three weeks of referral.
Patients who meet the eligibility criteria should be referred by eReferral with a completed EIA referral form (referrals received without an accompanying form will be rejected and returned).
document Early Inflammatory Arthritis referral form (211 KB)
ENT
- GP to Specialist Referral Proforma Tonsillectomy
- CCG Tonsillectomy Commissioning Policy
General Surgery
GP to Specialist referral proforma Hernia
The 3 Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
GP to Specialist referral proforma Gallstone Disease and Gallbladder Pathology
Home Oxygen Service
Please complete the HOS-AR referral form and email to This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01905 681062.
Lung Cancer Service
Please complete this urgent referral for document suspected lung cancer form (93 KB) . An accompanying referral letter is required for all patients.
On completion please fax to the Cancer Referral Centre 01562 754312 or 01562 513021.
This form should only be used for suspected cancer and in conjunction with the NICE Referral Guidelines for Suspected Cancer, June 2005.
Maternity
We are happy to continue to accept new booking referrals for our maternity services. These can be sent to either the Alexandra Hospital or Worcestershire Royal Hospital, as is current practice, for delivery on the Worcestershire Royal site.
The antenatal clinics and booking process remain the same and the different venues for booking appointments across the county will continue.
During the antenatal period, the midwife will continual assess and offer the appropriate choices for place of birth (home, Meadow Birth Centre or consultant-led Delivery Suite at Worcestershire Royal).
Neurophysiology
Referrals can be made using our Neurophysiology referral form or by sending a traditional letter to the department. All clinical information must be included and appointments will be made based on this information.
Paediatric Phlebotomy Service
Phlebotomy appointment service for under 18’s are held at a speclialiust children's clinic at the Alexandra Hospital, Redditch. Please note appointments are only available on certain days at certain times – we do not offer a ‘drop in’ service.
Direct dial number – 01527 512758
We will need a request on ICE if available or paper forms can be given to parents/carers.
Parents can telephone clinic to make appointment once request has been arranged.
The information we will need:
- Child’s name
- NHS number
- Address
- Phone number
- Date of birth
- Name of GP
Pathology
We provide high quality evidence-based cellular pathology, clinical biochemistry, haematology and blood transfusion and microbiology services from laboratories at the Alexandra, Kidderminster and Worcestershire Royal hospitals. We also provide pathology services for the Worcestershire Health and Care Trust and Worcestershire’s three Clinical Commissioning Groups as well as other healthcare organisations in the county. To find out more information about our pathology service and how to provide samples, please read our guidelines.
Speciality of Gynaecology
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
Speciality of Orthopaedics
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
- GP to Specialist Referral Proforma - Hip & Knee
- GP to Specialist Referral Proforma - Carpal Tunnel
- GP to Specialist Referral Proforma Symptomatic Knee Pain Non-Traumatic
- Musculoskeletal Surgery and Therapeutic Interventions Commissioning Policy
Speciality of Urology
The Worcestershire CCGs are working with Worcestershire Acute Hospitals NHS Trust to ensure that all patients are treated in line with the local commissioning policies.
In line with the agreed contract, the CCGs can decline the NHS funding of any treatment unless there is clear and demonstrable evidence of a patient’s compliance with the criteria in these local policies.
You can view the full list of commissioning policies using the following shared link: http://www.redditchandbromsgroveccg.nhs.uk/strategies-policies-and-procedures/commissioning-ifr-policies-a-z/
Vascular