HNY Policy and Pathway Repository - East Riding

Multiple specialities

Intra-provider referrals are transfer of a patient between specialists within a single healthcare organisation.

Inter-provider referrals are transfer of a patient between specialists in different healthcare organisations.

1. Conditions

For services commissioned by Humber and North Yorkshire ICB, intra-provider and inter-provider referrals are only funded if any of the following apply: 

• Urgent clinical need, including cancer or suspected cancer pathways and immediate ED opinions: Where immediate specialist review is required and delay would risk patient harm
• Same specialty / same condition referrals: For example, movement between subspecialties within the same specialty. NB Request for advice within the same specialty does not constitute a referral.
• Pathways agreed with the ICB: Where intra- or inter-provider transfer is a standard step in a pathway or for access to a tertiary service
• Pre-operative assessments: Including cardiology or anaesthetic review required before surgery.
• MDT related referrals: When involvement of another service is part of a recognised MDT process (not recorded as a new outpatient appointment).
• Condition-specific multidisciplinary management: For example – diabetes requiring renal/ophthalmology input or heart failure with renal dysfunction requiring joint renal cardiology input
• Safeguarding: Child or adult safeguarding concerns requiring specialist clinical involvement

2. Standards

These standards must be met for all intra- and inter-provider referrals:

• Consultants: Non-consultant clinicians should use the expertise of senior colleagues for advice prior to deciding whether to make onward referral to another service within secondary care.
• Adherence: Review the HNY Pathway and Policy Repository to check whether criteria in any relevant commissioning policy have been met if referring with expectation of a specific intervention and include such details in your referral.
• e-RS: Referrals to outpatient services should be made via eRS (or another ICB approved electronic system) where the pathway supports this.
• Audit: Referrals should be auditable, including source, rationale, and pathway alignment.

3. Monitoring and Audit Providers must:

• Monitor volumes of intra- and inter-provider referrals and other non-GP referrals monthly.
• Identify specialties with high or rising demand.
• Report exceptions or concerns to the ICB Quality Committee.
• Support periodic audits led by the ICB or provider governance teams.

4. Patient information requirements

Providers must ensure:

• Patients understand their right to choose a provider (in accordance with the relevant Regulations).
• Patients understand the intra- and inter-provider referral process
• Patients understand when their GP will receive information or resume responsibility for their care

 

The purpose of this policy is to: 

• Ensure consistent, safe, and equitable management of all intra- and inter-provider referrals. 
• Reduce unnecessary referrals that duplicate activity or create additional burden. 
• Support appropriate clinical pathways, including cancer and specialist MDT working. 
• Improve system performance, including RTT, outpatient utilisation, and alignment of capacity to population need. 
• Clarify provider responsibilities, approval mechanisms, and governance processes. 

 This policy applies to: 

• All acute, community, mental health and independent sector providers where consultant‑to‑consultant referrals occur within HNY ICS. 
• ED and SDEC are included as secondary care services for the purpose of this policy.
• All staff involved in creating, processing or triaging referrals. 

Out of Scope

• Inter‑Provider Transfers (IPTs)
• Sub‑contracted activity

Cross‑reference to separate IPT guidance in development.

Non-compliance may result in performance intervention, contract management action, or escalation through appropriate clinical governance channels. 

NHSE (2018). Consultant to Consultant Referrals: Good practice guide