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Referral for further advice or care is a decision that your GP or nurse will take with you. If you feel you need further help, please discuss it with them.  

To keep the process easy and convenient for you, the practice will endeavour to provide as much of your investigation and care as possible in the practice or locally in the community.

If you have private medical insurance and you wish to use it, please let the GP or nurse know straight away. This helps avoid starting the process for an NHS referral only to have to change to a private route later.

If your GP or nurse practitioner sees you and agrees you need further advice or care, this may often be obtained from another doctor or nurse within the practice. We have a number of clinicians with additional training and skills. For further information meet our dedicated team.

If the advice is needed from someone outside of the practice, your GP or nurse will discuss with you some of the options for your care. There are an increasing number of clinics run in community settings with highly skilled clinicians who have extended training to manage particular types of condition, including skin problems, joint and muscle problems and diabetes. They work with input from specialist consultants. These are sometimes called Professionals with Special Interest.



If you need advice from someone in a hospital, your GP or nurse will discuss with you which hospital you wish to be referred to. This is referred to in the NHS as choices. You may, at a later date, be contacted by representatives of the Department of Health to participate in a survey to see whether you have been offered choices.

In choosing where to have your outpatient appointment, you will be choosing where to receive your full treatment, if you need it. This will include your initial outpatient appointment and any other appointments for treatment (for example, inpatient care) or aftercare.

However, if you are not happy with your chosen hospital after your outpatient appointment, your GP can make you an appointment at another hospital.

If you need very specialised care, you may need to be referred by your consultant to another hospital. You may also be transferred to another specialty if the hospital doctor and your GP feel that this is more appropriate for your condition.

Your GP or nurse will ensure any agreed choice on a specific hospital doctor and/or hospital, is included in your referral letter. On the other hand, if you have no particular preference or several choices, the letter will make this clear.

We will aim to get the referral letter typed and sent to the next stage within 3 working days. An urgent referral will be completed within one working day.

Kingston Clinical Assessment Service (KCAS)

In most cases, your letter will then be sent to Kingston Clinical Assessment Service (KCAS). You will be sent a leaflet that contains information about KCAS, which we hope will be useful to you. The KCAS process is an assessment to ensure you get the most appropriate treatment. This will not delay your care and KCAS will contact you to take you through the next steps.

KCAS staff check all necessary information is included and pass the referral to the KCAS doctor for assessment. This doctor is drawn from a team of experienced practitioners.

The KCAS doctor reviews your referral and confirms the most suitable next step in your care.

KCAS will call you on one of your preferred telephone numbers to discuss your choice of service with you, before booking any necessary appointment.

Occasionally your GP will request that KCAS simply post you an appointment or you may choose this yourself.

There are some hospitals services that are as yet unable to book appointments using the Choose & Book computer system. KCAS will either arrange for an appointment to be posted to you or, in some cases, may ask you to phone the hospital's own booking number. This will take place within 2 weeks of your referral letter being received by KCAS. There may be a short delay between seeing your doctor and the letter arriving at KCAS.

Public Health Assessments

Due to the nature of some referrals we are required to seek approval for treatment from the Public Health Team at Clinical Commissioning Group (CCG). Approval is sought in respect of a referral which falls into one of the following categories:

Procedures where there is limited evidence of effectiveness

Procedures where initial conservative treatment is possible

Procedures which have a proven benefit, but for which a threshold for intervention may be appropriate

Procedures where NHS provision may be inappropriate

Full details abouot these referral criteria can be found at and click on  Public Health.

If your referral requires CCG approval KCAS will write to notify you. In each case specific criteria (set by the PCT) are looked at and a decision is then made, in consultation with your GP, about the appropriateness of the referral.

If approved, your referral will be passed on to the hospital, who will book your appointment and contact you directly. If not approved, your GP will be contacted in writing. At this stage your GP will be able to appeal against the decision.

Keeping your Appointment

Please keep your appointment and give as much advance notice as possible if you are unable to attend.

Follow Up

Any communication from the hospital will be sent to the practice. It may be copied to you as well. Please do make an appointment to discuss the contents if you would find this helpful. Or you may prefer to do so in a telephone call.

We will work with you and any specialist service to ensure that as much of your follow up as is appropriate is done in the practice or locally in the community.


Please feel free to discuss any aspect of your referral with your GP at any point in the process.

As a practice we monitor the quality of the services we use both in the practice, in the community and at hospitals. We would value any comments you have about your experiences.

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