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Acute & critical care medicine

NHS Scotland referral protocol

National Referral Protocol
National

The criteria in this protocol aim to ensure appropriate access to the following procedures. These procedures must NOT be routinely offered by NHSScotland unless these criteria are met. The main aim of this protocol is to ensure better access for people who are likely to clinically benefit and to reduce the waste and potential harm caused by inappropriate provision.

Please note

  • People should only be referred following a clinical assessment where there is a symptomatic or functional issue amenable to treatment.
  • All cases will be judged against the agreed criteria on an individual basis.
  • Referral does not guarantee that treatment will be offered. This must be communicated to the patient before the referral is made.
  • Referrals missing key information required for the assessment will be returned for completion before the referral can be considered.
  • A photographic assessment may form part of the pathway and may require attendance at a local NHS facility. The patient should be aware of this requirement before referral.
  • This pathway does not cover the primary treatment of trauma or cancer.

 

Referrer must first assess the following before taking the decision to make a referral under the Protocol. All criteria must be met prior to referral.

Physical criteria: all must be met.

Impairment of function

  • Functional impairment must be present if the patient is to be considered for treatment.
  • Only refer where there is a significant functional impairment which may be improved by treatment.

Body mass index (BMI)

  • BMI is a pre-requisite for a number of the procedures covered by the protocol.
  • Check the specific assessment criteria under the protocol.

Psychological distress: must be met.

Psychological distress

  • Referral under the protocol may be indicated where the patient has significant and prolonged psychological distress.
  • Check the specific assessment criteria under the protocol. Psychology assessment must be by the specialist Clinical Psychologists working with a regional centre.

Contraindications

Significant major life event

  • If a patient has had a major life event in the previous 12 months e.g. giving birth, relationship breakdown or a significant bereavement etc.
  • Consider deferring referral until after recovery. Psychological stability is a requirement before referral.

 

Referral is contraindicated where:

  • a patient has had an episode of self-harm within the last two years;
  • there is a previous diagnosis of body dysmorphic disorder;
  • the patient has a disproportionate view of the problem following your examination;
  • the patient currently has:
    • a major depressive illness;
    • an active delusional or schizophrenic illness;
    • an eating disorder;
    • obsessive compulsive disorder;
    • substance abuse problem.