We have provided some diagrams to illustrate models that Restricted Services functionality can support.
Tertiary or Restricted Secondary Care Service Model
In this example, the National Eye Hospital offers specialised tertiary services. These services are published in the Directory of Services (DOS) as restricted services. The DOS entry lists all available, authorised services that referrers can initially access.
Clinicians within the authorised services are able to redirect to or (where they themselves are a clinical assessment service) refer-on to the restricted services, where clinically appropriate.
Clinical assessment model
In this example, the local CCG has commissioned Newtown Hospital to provide an Orthotic Service and The Village Hospital to provide a specialised Podiatric Service, with surgical input. The CCG also provides a Community Physiotherapy Service. All of these services are restricted services and do not accept referrals directly from GPs within the CCG.
The pathway to all these services is via the Newtown Musculoskeletal Assessment Service. This service is an authorised service for the others. Referrals received into this service are triaged and/or treated. Those referrals that are clinically appropriate can be referred-on to the relevant restricted service.
GPs can see the restricted services, but cannot refer to them directly - they will instead be directed to refer via the authorised service, Newtown Musculoskeletal Assessment Service.
Referral Assessment Service Model
In this example, the local paediatric referral pathways are complex and referrers often refer into an inappropriate service so the service provider has set up a Referral Assessment Service (RAS).
The RAS takes all paediatric referrals into the hospital, triages the referral and, where appropriate passes the referral on to the appropriate clinic. The specialist paediatric clinics are all restricted and the RAS is the only service that is authorised to refer into them.
Authorised Referrer Model
In this example, two GPs at neighbouring practices are looking for an appropriate service for their patient who has a spinal problem. Both GPs can search and see that the National Neurosciences Hospital Spinal Service might be appropriate. This service is however a restricted service and the first GP (Dr Smith) is not an authorised referrer. This GP sees, within the search results, a list of alternative authorised services that he can refer to as part of the pathway.
Authorised Organisation Model
Newtown CCG has commissioned a local vasectomy service for only the practices in a specific location or Federation. This service is therefore defined as a restricted service. The service is an initial referral service but is restricted to authorised organisations - those individual practices which the service is commissioned for.
Practices in Oldtown Locality can see the service but cannot refer to the service.
This model uses Service Restriction to support this process, but the ability to commission services (in e-RS) at referring practice level now means that only those practices which have commissioned a service will be able to see and refer into it. This removes the need for such services to be restricted and may be a more effective model for primary care menu services.