Published: 24/03/2005, Volume II5, No. 5947 Page 29

In 2004, City and Hackney taching primary care trust began developing its first tier-2 services covering rheumatology, orthopaedics and dermatology. These offer good potential for improving waiting times by using GPs with special interests in primary care rather than secondary care.

The PCT and Homerton University Hospital foundation trust set up joint project teams to agree the pathway and protocols for screening GP referrals.

But how would referrals to the new services be screened against the protocols? Part of the answer was to use extended scope physiotherapists and GPs with special interests as screening experts. The PCT also set up a clinical assessment service (CAS) to centralise the assessment and administration of referrals.

From October 2004 all rheumatology, orthopaedic and dermatology referrals started going to CAS. The referrals are scanned, logged and presented for screening, relieving practices of a considerable administrative burden. Screening takes place at CAS or at GP surgeries. Patients telephone CAS to book their appointment five days after their visit to the GP.

Now, 40 per cent of rheumatology, 60 per cent of orthopaedic and half of dermatology referrals in the PCT are made to primary care clinics.

From the end of January all GP referrals started going through CAS, with assessments carried out where primary care services are developed.

In 2005-06 the full development of CAS will offer GPs the benefit of outsourced referral administration.

Cathy Williams is operational lead for City and Hackney Teaching PCT's clinical assessment service. The service is planning to hold a free conference, open to other PCTs, on CAS. For conference details e-mail desouza. chpct. nhs. uk