wweellsshh cclliinniiccaall ccoommmmuunniiccaattiioonnss

WWeellsshh CClliinniiccaall

CCoommmmuunniiccaattiioonnss GGaatteewwaayy

((WWCCCCGG))

UUsseerr GGuuiiddee

PPoowwyyss TTeeaacchhiinngg

HHeeaalltthh BBooaarrdd

Author(s): Peter Noneley

Linda Powles

Owner: NWIS

2 19 February 2015 Project Name: WCCG Document Title: Complete WCCG Guide PtHB – V2.2

Training Document History

Version Revision Date Summary of

Changes

Author

1.0 20th July 2012 Linda Powles

1.1 13TH August 2012 Additions to FAQ Linda Powles

1.2 16th October 2012 Appendix of Attachment Types added

Linda Powles

1.3 29th October 2012 Customised for Powys Linda Powles

1.4 26th November 2012 New Protocol & Powys Commissioning guidance

Linda Powles

1.5 5th February 2014 Reference to deleted referrals amended

Linda Powles

1.6 11th February 2014 Updated Disability Section

Linda Powles

1.7 18th February 2014 Guidance on Yellow Warning Triangle

Linda Powles

1.8 28th May 2014 ABHB attachment reference amended

Linda Powles

1.9 31st May 2014 Changes to Cancer (USC) referrals in ABHB

Linda Powles

2.0 18th July 2014 Addition to FAQ Linda Powles

2.1

19th December 2013

Update RN 2.4.7

Linda Powles

2.2

23rd June 2014

Change to Service Desk contact number

Linda Powles

Useful Contacts

Contact Name Contact Details

Primary Care Service Desk 0333 200 8048

Workforce & Organisational Development Email: Learning&[email protected]

mailto:Learning&[email protected]


Contents

The WCCG Referral Process ..................................................................................... 5

Logging on to WCCG .......................................................................................... 6

WCCG Home Screen ................................................................................................. 7

e-REFERRALS .......................................................................................................... 8

Create a Referral ................................................................................................. 9

Referral tabs ..................................................................................................... 10

Clinical Data tab ................................................................................................ 11

Referring GP/Recipient Tab .............................................................................. 13

Past Medical / Family History Tab ..................................................................... 14

Medications Tab ................................................................................................ 15

Risks and Warnings Tab ................................................................................... 16

Demographics Tab ............................................................................................ 17

Administration Tab ............................................................................................ 18

Reviewing a Referral Letter ............................................................................... 19

Parking a Referral ............................................................................................. 20

Cancelling / Deleting an e- Referral .................................................................. 20

Attaching Documents or Images to a Referral .................................................. 21

Spellcheck Facility ............................................................................................ 21

Adding Words to the Dictionary ......................................................................... 22

Removing Words from the Dictionary ................................................................ 23

Validations ........................................................................................................ 24

Referrals Worklist .............................................................................................. 25

Managing the Referral Worklist ......................................................................... 27

Search for Referrals .......................................................................................... 28

Auditing ............................................................................................................. 29

Audit Trail – Referral Specific ............................................................................ 30


ADVICE REQUESTS – Available in 2014 ................................................................ 31

Advice Tab ........................................................................................................ 32

Patient Tab ........................................................................................................ 32

Medication Tab.................................................................................................. 33

Administration Tab ............................................................................................ 33

Advice Request Example .................................................................................. 34

Advice Responses ............................................................................................ 34

Advice Response Example ............................................................................... 35

SUPPLEMENTARY MESSAGES – Available in 2014 ............................................. 36

Supplementary Message Tab ........................................................................... 37

Patient Demographics Tab ................................................................................ 37

Supplementary Administration Tab ................................................................... 38

Original message Administration Tab ............................................................... 38

e-DISCHARGES ...................................................................................................... 39

Log in to WCCG ................................................................................................ 40

E-Discharge Worklist ......................................................................................... 40

Managing e-Discharges .................................................................................... 41

Discharge Notification Document Management ................................................ 43

Save an e-Discharge Notification – Non Docman ............................................. 43

Save an e-Discharge Letter – Non Docman ...................................................... 44

Filing e-Discharge Notifications ......................................................................... 45

Search for e-Discharge Notifications ................................................................. 46

Frequently Asked Questions .................................................................................... 47

Common Attachment Types ..................................................................................... 50

Referrals via Powys Commissioning ........................................................................ 51

Health Care Entities & Their Services ...................................................................... 53


THE WCCG REFERRAL PROCESS

The Welsh Clinical Communications Gateway (WCCG) sends electronic

referrals from a GP Practice to the Hospital

As the referral progresses, its status changes and is indicated in the Worklist

GP Send referral to Hospital

GP Worklist Status

Redirected

CRC

Submitted

Not yet opened.

Medical Records

Printed

Sent to the consultant.

CRC

Opened

Redirected to Medical

Records

Medical Records

Submitted

Not yet opened

Medical Records

Opened

Hospital Receive referral

from GP

Viewed

Printed

NB:

Depending on

Secondary Care

processes, these

2 steps may be

omitted

*Some icons are not visible with

ABHB referrals


LOGGING ON TO WCCG

Access to the WCCG is via the GP Clinical system.

See the relevant supplement for your specific Clinical System to access the WCCG.

When you first log in, you will be required to change your password (this is cAsE

seNsiTive) for security purposes. There are three security questions to select and

answer in the event you forget your password.

Select the questions from the drop down boxes and enter your answers in the text

boxes below each question. You may enter your own security questions. On

successful completion of the process, the following message is displayed.

Should you forget your password, you may click on the link

You will be asked for characters from the answers provided to the security questions.

A new password will need to be created when the correct answers have been

supplied.


WCCG HOME SCREEN

The tasks you can undertake in WCCG will be determined by your log-in. For

example, Clinicians and staff who generally create referrals will be able to access

both the ‘Messages’ and ‘New Messages’ links whereas an Administrator who

monitors eDischarges, may only have the ‘Messages’ link available. Some staff,

such as Practice Managers, may have access to system configuration and user

administration settings. User accounts are generally managed by the Practice

Manager with accounts currently created by NWIS Service Desk.

When the Gateway is accessed via a Patient record, the Patient’s name and NHS

number will be displayed above the WCCG News section.

In the main body of the ‘Home’ screen, the user is provided with the latest news

regarding WCCG and any information relevant to your Health Board area.

The ‘Waiting Times’ link will take users to the WCCG support page with hyperlinks to

the Welsh Government and HOWIS sites providing information and statistics on

waiting times in Wales.


E-REFERRALS

Referral Terminology

Create – Start a new referral

Park – To save a referral as a draft copy before sending at a later time.

Print – Print a paper copy of an e-referral (or a batch of e-referrals)

Attachment - A file or image document that may be attached prior to a

referral being submitted to Secondary Care

Submitted – An e-referral sent to a Secondary Care provider.

There have been a number of changes to the WCCG protocol that has been in use.

A significant change surrounds the authorisation of the e-referral prior to sending.

Previously, it was a requirement that the e-referral was checked by a GP before

sending. This has now changed to reflect the fact that Practices have processes in

place for the creation and submission of e-referrals by administration staff.

Therefore, any approved user within the practice can click the ‘Authorised by

Practice’ check box. It will be the responsibility of the GP Practice to agree a

process by which this check is completed.

Mandatory fields will need to be completed prior to clicking on the ‘Send’ button.

These fields are displayed with PINK text boxes; some pink fields will be pre-

populated with information drawn from the Patient record.

Examples of required input

Example of pre-population


CREATE A REFERRAL

To create a new referral, from within a patient’s consultation screen, log into WCCG

and from the ‘Welcome’ screen select ‘New Message’ and ‘Referral’ from the

navigation panel on the left.

The next screen displayed is the ‘New Referral’ screen with the Secondary Care

providers’ information in drop-down boxes.

Using the drop down boxes, select the destination and discipline required.


REFERRAL TABS

Having logged into WCCG from within a patient’s consultation screen, the referral is

pre-populated with information drawn from the clinical system. It is important that

sensitive information with no relevance to the referral is not included in the referral.

As the referral template is automatically populated with past medical and family

history, it is the responsibility of the referring GP to review the content of referrals

and remove any unnecessary sensitive data before submission.

At the bottom of each referral tab screen, there are the following buttons:

Cancel a referral letter

Attach an image or document to a referral letter

Preview the referral letter

Spell check the referral letter

Park puts the draft referral on hold

Send the referral letter to Secondary Care

A new ‘Favourite’ may also be

created by clicking on the ‘Add

Favourite’ button

at the bottom of the screen A favourite location may also be

removed if no longer required.

When the Secondary Care provider fields have been completed, the

user needs to click on ‘Create’ to move on to the next step in the

process.


CLINICAL DATA TAB

The ‘Clinical’ tab now contains a large text box that the referral letter may be typed

into.

Referral content guidelines suggest the following should be included where

appropriate:

1. Symptoms including duration and site of described pain

2. Conservative management tried

3. Clinical examination findings

4. Types of analgesia given e.g. Co-codamol + Amitriptyline, Gabapentin

5. Have you discussed and would the patient consent to one of the following:

a) further investigation such as the relevance of MRI?

b) intensive rehabilitation (FRP) physiotherapy and analgesia?

c) intervention, e.g. surgery, spinal injection?

d) referral to pain management services?


Within the Clinical tab, there are additional icons to assist with the referral process.

Spell checking may be carried out either by using the spell check button at the

bottom of the screen, or by using the icon to the right of the ‘Presenting Complaint

/ Problem’ section and the ‘Clinical Details’ section.

In relation to the ‘Clinical Details’ section, it is advisable to consider the duty of

confidentiality owed to the patient. Comments entered in free text boxes may be

disclosed to the patient in the event of an information request.

When entering dates, either use the calendar icon to the right of the ‘Date

Recorded’ box or if manually entering a date, use the dd/mm/yyyy format. You may

also click on the current date displayed beneath the calendar, if appropriate.

Current date -

click on to insert


REFERRING GP/RECIPIENT TAB

The ‘Referring GP/Recipient’ fields will be pre-populated from the Clinical System

and from the initial selections made at the start of the referral process. If the referral

is being created by an administrator, then the referring GP’s name will need to be

selected from the drop down box beneath the GP Practice field.

It is within this tab that the ‘Authorised by Practice’ checkbox can be found. Once

the referral has been checked for completeness by the referring GP, this checkbox

must be checked before the referral may be sent.


PAST MEDICAL / FAMILY HISTORY TAB

Pre-populated from data within the patient record.

Please note that the ‘Date Recorded’ heading is specific to iSoft clinical systems. For

all other clinical systems, the heading will be ‘Date of Onset’.

Information irrelevant to the referral may be deleted by using on the left hand

side of the individuals rows. The deleted information remains visible with the text -

displayed as being ‘crossed out’. This information may be re-instated by using the

‘Undo’ button.

Deleted rows (whether hidden or displayed) are ignored when previewing the referral

letter, thus allowing users to view the letter as it will be finally generated.

If the user ‘Parks’ a referral, any rows marked as ‘deleted’, including any hidden

deleted rows, will be permanently removed from the referral. These deleted rows

cannot be re-instated when the referral is re-accessed.


MEDICATIONS TAB

Pre-populated from data within the patient record.

Information irrelevant to the referral may be deleted by using on the left hand

side of the individuals rows. The deleted information remains visible with the text -

displayed as being ‘crossed out’. This information may be re-instated by using the

‘Undo’ button.

As with ‘Past Medical/Family History, any deleted text will remain visible on the

screen but can be hidden by using the ‘Hide Deleted Rows’ button that appears

when any row is deleted. The deleted rows are ignored when previewing the referral

letter, thus allowing users to view the letter as it will be finally generated.

If the user ‘Parks’ a referral, rows marked as ‘deleted’ including any hidden deleted

rows, will be permanently removed from the referral. Deleted rows cannot be re-

instated when the referral is re-accessed.


RISKS AND WARNINGS TAB

Pre-populated from the Patient’s clinical record, this tab covers ‘Life Style Risks’

(BMI, blood pressure etc.,) and ‘Clinical Alerts’ such as ‘Allergies’, ‘Intolerances’

and ‘Other Risks and Warnings’.

In the ‘Clinical Alerts’ section, information may be added or deleted by using the

‘Add Row’ button or deleted by using on the left hand side of the individual

rows. Deleted information remains visible with the text displayed as being ‘crossed

out’. The text may be re-instated by using the ‘Undo’ button.

Deleted text will remain visible on the screen but can be hidden by using the ‘Hide

Deleted Rows’ button that appears when a rows is deleted. Deleted rows are

ignored when previewing the referral letter, thus allowing users to view the letter as it

will be finally generated.

Again, if the user ‘Parks’ a referral, rows marked as ‘deleted’ including any hidden

deleted rows, will be permanently removed from the referral. Deleted rows cannot

be re-instated when the referral is re-accessed.


DEMOGRAPHICS TAB

All mandatory fields in the ‘Demographics’ tab should be completed through the

pre-population of data from the patient’s record in the clinical system.

Some fields are supported with a ‘Help’ facility; click on the icon


ADMINISTRATION TAB

This tab may be used to enter any specific information. A drop down box can be

used to indicate whether a patient will accept short notice of an appointment; another

option available is whether a language interpreter or signer is required. The free text

box may be used for other pertinent information relating to the patient referral (e.g.

hard of hearing). An enhanced section on Disability Information has been included.

Veteran status

Since 2008, all war veterans with health conditions that may be related to their

military service are entitled to priority treatment. The concept of priority treatment is

not for the veteran to be seen quicker than patients with a greater clinical need, but,

for conditions related to military service, they would at their first outpatient

appointment, be scheduled for treatment quicker than other patients of similar

priority.

Please note that the patient is under no obligation to declare themselves a veteran.


REVIEWING A REFERRAL LETTER

Prior to ‘Parking’ or ‘Sending’ a referral, the letter may be reviewed by clicking on the

‘Preview Letter’ button at the bottom of the WCCG screen.

The highlighted area displays where the text typed in during the referral will be

displayed along with the ‘Dear Colleague’ salutation.

There is an option to ‘Print’ the letter (the button is at the top of the screen).

Note that any information entered and subsequently deleted during the referral

creation process, is not displayed in the ‘preview letter’ state. Deleted information

may be re-instated by using the ‘undo’ button against the relevant rows within the

referral until such time the referral is ‘Parked’ or ‘Sent’.


PARKING A REFERRAL

A referral that has been created but has not been completed may be ‘Parked’. This

step of the process allows the user to return to the referral at a later time to complete

it, either by filling in fields that have not yet been completed or by attaching a

document in support of the referral. At any point during the creation of a referral, the

user may click on ‘Park’ to save the file.

If the user ‘Parks’ a referral, any rows marked as ‘deleted’ including any hidden

deleted rows, will be permanently removed from the referral. These deleted rows

cannot be re-instated when the referral is re-accessed.

To retrieve a ‘Parked’ referral, the user will need to retrieve it from the Worklist. The

status of a parked referral in a worklist is listed as ‘In Progress’. Double click on the

patient’s name to open the referral

CANCELLING / DELETING AN E- REFERRAL

An e- referral may be cancelled at any time prior to sending. A referral cannot be

cancelled (or deleted) once it has been sent. To cancel a referral, the user will need

to locate it in the Worklist.

During the creation process, the referral may be cancelled at any time by using the

‘Cancel’ button.

Once the referral has been located in the Worklist – do not open it – but use the

‘Options’ icon on the left hand side of the screen; select ‘Cancel Referral’.

The referral will then be displayed as ‘Cancelled’ in the ‘Status’ column. It will

continue to be displayed in the worklist – it cannot be ‘Uncancelled’.

To delete a referral, using the same process as cancelling, locate the referral – do

not open it – and using the icon, select ‘’Delete Referral’. The referral will

then be deleted from the Worklist.


ATTACHING DOCUMENTS OR IMAGES TO A REFERRAL

To attach documents or images to support a referral, please see the relevant Clinical

System Supplier supplement for guidance as this process varies between clinical

systems. Please note, however, that the information in the attachments should be

relevant to the referral and contain patient identifying information.

Functionality that had been present within the drop down menu options that provided

the ability to send an attachment after a referral was submitted has been removed.

Under no circumstances should an attachment be sent after a referral has

been submitted. If additional information needs to be sent after a referral has

been submitted, the user should telephone the recipient and either

a) request that the original referral be cancelled and subsequently create and

submit a new referral with the attachment added

b) make arrangements with the recipient to send the additional information

SPELLCHECK FACILITY

There is a spellchecking facility within WCCG which uses a dictionary that

recognises medical terminology. To use the Spellcheck facility, click on the

‘Spellcheck’ button which can be found at the bottom of the tab screens.

If the Spellcheck tool does not recognise the word, it will provide suggestions to

correct the spelling.

Allows users to configure Spell Check tool – see panel below

Ignore a single instance of a specific spelling anomaly


Ignore all instances of a specific spelling ‘anomaly’

Change a word to the suggested spelling correction

Change all words to suggested spelling corrections

Add a word to the dictionary

Close the Spell Check tool

ADDING WORDS TO THE DICTIONARY

There may be occasions where the spell-checker does not recognise a word. These

new words may be added to the dictionary.

If a user wishes to

configure the Spell Check

tool, they may select any

of the suggested options

and click ‘OK’ to confirm

choices

Step 1 – click the ABC

tick

Step 2 – the

highlighted word is

displayed – click on

the ADD button

Step 3 – At the end of

the spellcheck – click on

Save


REMOVING WORDS FROM THE DICTIONARY

Words that have been accidentally added to the dictionary may be removed.

Step 5 – Click the Close button

Step 1 – click the ABC tick

Step 2 – click the

OPTIONS button

Step 3 – Click the User

Dictionary tab at the top

Step 4 – Select the word

to remove – choose

Remove Word – click

OK


VALIDATIONS

If any mandatory fields are left incomplete, the user will be prevented from sending

the referral until the omissions have been rectified.

The user can either navigate to each tab to complete the fields highlighted as

incomplete, or by double-clicking on the blue hyperlink, the system will automatically

take the user to the correct field in the relevant tab for completion.


REFERRALS WORKLIST

Information Symbols

Symbol Meaning

Meaning Symbol

Pink for a Referral

Has been Viewed by the receiver – icon not visible with ABHB referrals

Priority set to ‘Urgent’

Has been ‘Filed’

Referral with Attachment

Has been printed – icon not visible with ABHB referrals

(USC) Urgent Suspected Cancer

Supplementary Message (2014)

Advice Request (2014)

Advice Response (2014)

A yellow triangle denotes mismatched or incomplete information has been provided. A

check should be undertaken on the field highlighted as displaying the erroneous data.

User Icons

Icon Action Action Icon

Display or hide the Search panel area above the Worklist.

Click to Filter the list of referrals. Blue indicates the Filter is OFF

Click to set Status, Attach files,

Cancel, Delete or send Email. Red indicates the filter is On.

Click to select multiple referrals;

useful if you need to print a batch

of referrals.


Status Meaning

In Progress The referral has not yet been completed.

Draft to be checked by GP Awaiting GP check

Submitted The referral has been sent

Cancelled The referral has been cancelled by the

Practice

Deleted The referral has been deleted by the

Practice

Delivered Accepted by Secondary Care

Rejected

Rejected by Secondary Care. The referral

did not match the criteria: the referral

may need to be resubmitted.

Redirected The referral has been redirected within

Secondary Care

Paper copy sent to Addressee

The referral has been printed in

Secondary Care and passed to the

relevant department/consultant

On waiting list The referral has been accepted and the

patient is on the waiting list

Forwarded to another Clin/Spec The referral has been passed to the

relevant department/consultant

Recalled by GP Status changed by Secondary Care on

receipt of request from Practice

Written advice provided Secondary Care have provided a written

response

Awaiting Prioritisation With Clinician awaiting prioritisation

Prioritisation Complete Awaiting booking of appointment

Verbal advice given Secondary Care have provided a verbal

response

Insufficient info provided

Review the original. Supplementary

Messages in 2014 provide a mechanism

to update/amend

Returned not accepted Letter will be sent to Practice notifying of

decision

On hold pending enquiry Registration office awaiting further

information

Intervention not funded Review Secondary Care providers

The ‘Status’ column on the right hand

side of the worklist indicates the

progression of the referral while in the GP

Practice and subsequently Secondary

Care system.


MANAGING THE REFERRAL WORKLIST

To access the worklist screen, log on to the WCCG

And from ‘Messages’ go to ‘Referrals’.

The referral Worklist screen for patients in the Practice will be displayed.

To continue with an ‘in progress´ (‘parked’) referral, double click on the patient’s

name to open the parked referral. On completion of the referral, using the ‘Options’

icon, the status may then be changed to ‘Draft to be checked by GP’. Once a

referral status has been changed to ‘Draft to be checked by GP’, the status cannot

be changed. The referring GP/Clinician may then access the referral to check and on

clicking ‘send’, the referral status will change to ‘submitted’.

To view an individual patient’s ‘submitted’ referral,

double click on the patient’s name to open a copy of

the referral letter.


SEARCH FOR REFERRALS

The worklist will only display referrals being held on the WCCG system; the list will

not display any referrals made outside of the WCCG.

There are two ways to search for information on referrals; you can either ‘Filter’ the

columns or enter ‘Search’ criteria in the search fields.

Or you can search for referrals by patient name or between given dates. Click on the

magnifying glass if the ‘Search for Referrals’ panel is not displayed. Click on

the calendars to change the date fields.

The default dates provided by the calendar are one month apart i.e. one month back

from the current date. This may be amended by clicking on the calendar and

selecting the required dates.

Searches may also be carried out against any column that has the blue in the

column headers. This may include searching for specific categories of referral, such

as ‘Urgent’ or ‘USC’.

To reset the columns after filtering, click on the red in the column header.

A button is also available on the lower right hand corner of the Worklist screen.

To ‘Filter’, use the blue in the column headers

or against the patient’s name (the search is

based on the patient’s NHS number)


AUDITING

The Audit Trail allows the user to view historical information regarding referrals sent

through WCCG. Using the drop down boxes and calendars on the Audit screen, the

user can define the criteria for the search. For example:

If the search criterion is to include the HCE (Healthcare entity) sections, please note

that you can only have one HCE in each of the HCE fields. For example, you can

search for referrals sent from one GP Practice to one speciality at a Secondary Care

unit.

When selecting a HCE, a new window will open and there is a directory structure

that will require the user to navigate by using the ‘+’ and ‘-‘signs to expand and

collapse the structure.

Either manually enter dates in the ‘From’ and

‘To’ date boxes or click on the calendars to

select dates. The default dates are 1 month

apart from the current date back.


AUDIT TRAIL – REFERRAL SPECIFIC

In the event of a query relating to a specific referral, it is possible to view the audit

trail for that specific referral. The information contained in an audit trail should not be

divulged to a third party.

In the WCCG Worklist, locate the referral that you wish to check the audit trail on.

The stages of the referral will be displayed along with the details relating to the user

who undertook processes.

In the ‘Options’

menu select ‘View

Audit Trail.


ADVICE REQUESTS – AVAILABLE IN 2014

Where advice in relation to a patient needs to be sought, rather than a referral made

to Secondary Care, the clinician may use the ‘Advice Request’ option from the

navigation panel.

The Advice Request may be sent to either another GP practice in the NHS Wales

directory or to a Secondary Care location; the process is similar to the creation of a

referral in that the recipient’s details need to be selected from the drop down lists.

The Protocol used is the ‘General Advice Request’.

As with an e-referral, the Advice Request will open in a new screen with the ‘Patient

Details’ and ‘Medication’ tabs pre-populated from data copied from within the clinical

system.


ADVICE TAB

As with e-referrals, PINK fields are mandatory.

The advice sought can be entered in the free text box. The ‘Consent to share’

should be gained from the patient.

If there is an element of sensitivity in relation to the advice request, then the radio

button should be checked. This will invoke a ‘Break Glass’

event to view the message.

PATIENT TAB

The patient tab is pre-populated with the patient demographics.


MEDICATION TAB

This is pre-populated with information drawn from the clinical system. As with e-

referrals, this may require editing to remove any irrelevant information.

ADMINISTRATION TAB

As with e-referrals, the Advice Requests may be parked for completion at a later

time. Attachments may also be sent if required.


ADVICE REQUEST EXAMPLE

To view the Advice Request prior to sending, click on the ‘Preview Letter’ button.

This Advice Request may also be printed out, if required.

Click on ‘Send’ and then click on ‘Proceed’ to submit the Advice Request. In the

worklist, a submitted Advice Request is identified by a yellow triangle (pointing to the

right)

ADVICE RESPONSES

Responses to Advice Requests will be displayed in the Worklist with a yellow triangle

(pointing to the left)

Click on the patient’s name in the worklist to open the response.


ADVICE RESPONSE EXAMPLE

The response may be printed as well as saved to file and subsequently imported into

the patient record. This may require the creation of a folder in which to store the

response temporarily.

To save the Advice Response, select the ‘Save to file’ button from the top of the

Advise Response.

A dialogue box will appear requiring the user to navigate to the temporary WCCG

folder which will be used to store the response. You may at this point, change the

File name to one that is more identifiable, for example “John Doe Advice Response

12th April 2012”.

Click on ‘Save’. Once saved, it may then be attached to the Patient’s record within

the clinical system.

Any files saved in a temporary location should be deleted once they have been

attached to the patient record. This is in line with Record Management Guidance.

In the event of a query, it will also be possible to check the audit trail of an Advice

request using the same process as that of an e-referral.


SUPPLEMENTARY MESSAGES – AVAILABLE IN 2014

When a referral has been submitted, there may be occasions where additional

information pertinent to the referral becomes available after submission. Using the

‘Supplementary Message’ option allows the additional information to be sent which

relates it to the original referral.

To send a Supplementary Message, the original e-Referral that has been submitted

will need to be located in the Worklist.

The user will need to click on the Options icon

From the menu list that is displayed, select ‘Send Supplementary’

A new screen will be displayed referencing the original referral,

From the menu list that is

displayed, select ‘Send

Supplementary’


From the Protocol drop down box, select the General Supplementary template

Click on ‘Create’ to continue the process.

SUPPLEMENTARY MESSAGE TAB

The free text Message box is mandatory; consent to share should be sought. If the

information contained is of a sensitive nature, then a Break Glass event will be

invoked requiring a password to view the supplementary message.

From the Priority drop-down box, it is possible to change the priority of the referral

from ‘Routine’ to ‘Soon’ or ‘Urgent’ if the condition of the patient has changed.

PATIENT DEMOGRAPHICS TAB

The Patient

Demographics

will be pre-

populated with

the original

patient details.


SUPPLEMENTARY ADMINISTRATION TAB

ORIGINAL MESSAGE ADMINISTRATION TAB

The Supplementary

Administration fields

may need to be

checked/completed

prior to sending the

message.


The final tab in the Supplementary Message screen contains the original information

pertaining to the submitted referral.

On completion of the message, the user may click on ‘Send’; if any mandatory fields

are incomplete, the user will be prompted to complete these fields before sending

the message. As with e-referrals and advice requests, the user may ‘Park’ the

message prior to submission. Again, attachments may also be included.

Click on ‘Proceed’ to complete the submission of the message. The original referral

will now indicate that a Supplementary message has been received – as indicated by

the green cross.

E-DISCHARGES

WCCG enables Secondary Care providers to send an electronic communication to

notify a GP Practice of a patient’s discharge from their care.

A number of safety nets have been incorporated into the process including a paper

copy being given to the patient to support out-of-hours services and the addition of

the discharging doctor’s bleep number if further details are required.

Practices will want to adapt their processes for ensuring that GPs view e-discharges

so that they are processed in line with current practice arrangements. These

arrangements vary from practice to practice.

Key considerations are:

Discharges received via the WCCG need to be attached to the patient

record

GPs need to review some or all discharges received via the WCCG, in

line with existing practice processes.

The e-Discharge notification is sent in the format of RTF (Rich Text Format). The

RTF format can be opened by Microsoft Word application or even the WordPad

application that comes free with Windows.


LOG IN TO WCCG

From within the clinical system -but with no patient selected- log on to the WCCG.

On successful log in, click on the text “You have xx new Discharges”.

E-DISCHARGE WORKLIST

Information Symbols

Discharge

Notification

Viewed

Options Menu

Filed

Filter OFF

Filter ON

Attachment

RTF Document

Printed


MANAGING E-DISCHARGES

To open a discharge notification, click on the patient’s name.

The notification may be printed using the PRINT option at the top of the Notification;

the status column in the Worklist will display a printer icon to indicate that the

notification has been printed.


Click once on the document symbol.

The Discharge Letter may be printed using the PRINT option at the top of the

Notification; the status column in the Worklist will display a printer icon to indicate

that the notification has been printed.

The worklist will show the list of

new Discharge Notifications –

click once on a paperclip symbol

in a notification


DISCHARGE NOTIFICATION DOCUMENT MANAGEMENT

In the absence of Docman functionality to save Discharge Notifications and Letters,

there are alternatives that may be used. The first is, where possible, to print off the

Notification and the Letter and scan them. The scanned files may then be attached

to the Clinical Record. A second alternative is detailed in the next section – Saving to

a Temporary Folder.

SAVE AN E-DISCHARGE NOTIFICATION – NON DOCMAN

An e-discharge notification may be saved to an electronic folder as a temporary

measure.

The first step is to create a folder on a shared drive to temporarily store the WCCG

discharge, after it has been downloaded from WCCG and before they are attached

to patient records. The folder should be easily identifiable, using a naming

convention such as ‘WCCG TEMP’ or something similar.

To save the e-discharge, select ‘Save as’ from the Word processing program menu.

The dialogue box will appear requiring the user to navigate to the temporary WCCG

folder which will be used to store the notifications. You may at this point, change the

File name to one that is more identifiable, for example “John Doe Discharge 12th

April 2012”.

Click on ‘Save’ to

temporarily save the file. On

completion, it may then be

attached to the Patient’s

record within the clinical

system.


SAVE AN E-DISCHARGE LETTER – NON DOCMAN

Attached to the Discharge Notification is the Patient’s Discharge Letter. To open the

Discharge Letter, the user must click on the paperclip icon in the Worklist against the

associated Notification.

The Discharge Letter will also need to be saved into the Patient record alongside the

Discharge Notification.

To save the Discharge Letter, select the ‘Save to File’ from the top section of the

Discharge Letter.

A dialogue box will appear requiring the user to navigate to the temporary WCCG

folder which will be used to store the Notifications and Letters. You may at this point,

change the File name to one that is more identifiable, for example “John Doe

Discharge 12th April 2012”. As the file extension (either .html/ .rtf/ .doc) will differ

from the Notification, this will allow you to save the Discharge Letter with the same

name.


FILING E-DISCHARGE NOTIFICATIONS

The Filing status is used to indicate that the Discharge Notification has been

processed by the Practice. After the ‘Filed status has been set, the Discharge

Notification will no longer appear in the list of new discharges. The button to access

the ‘Filed’ status is in the Discharge letter and setting the ‘Filed’ status does not

actually store any files on the WCCG or your computer – the purpose is purely

administrative.

The process is as follows:

1. Ensure you have no patient selected in the GP clinical system.

2. Log on to the WCCG

3. Click on the hyperlink “You have X new Discharges” – the worklist screen will

appear.

4. Click once on the patient name.

5. Click once on the ‘Change Status’ button

6. Put a tick in the check box marked ‘Filed’.

7. Click ‘Set’

The status column in the worklist will now display a filing cabinet icon. The

discharge notification will no longer appear in the list of ‘New’ discharges, but will be

available in the list of received discharge notifications.


SEARCH FOR E-DISCHARGE NOTIFICATIONS

The Search facility allows users to locate discharge notifications in the WCCG that

have been processed (such as ‘Printed’ or ‘Filed’) but no longer appear in the list of

new Discharge letters. The Search facility cannot locate referrals or documents held

within the Practice’s clinical system.

The process is as follows:

1. Ensure you have no patient selected in your GP clinical system

2. Log on to the WCCG

3. From the Navigation panel, select ‘Messages’ then ‘Discharge’.

4. Type the information to search for in the Search criteria

5. Click ‘Search’ and the Worklist will display the discharges matching the

search criteria.


FREQUENTLY ASKED QUESTIONS

When I click on ‘Create’, I’m unable to see the pop-up Referral screen.

If pop-ups have been disabled, this will be indicated by a yellow bar at the top

of the screen.

To allow the referral process to continue, click on the yellow bar and select

‘Display Blocked Content’.

Why is a WCCG referral rejected?

A WCCG referral will be rejected if it does not meet the access criteria under

the INNU or WHSSC policies. This is the same policy that applies to referrals

sent by letter. Upon rejection the Status of the referral will be changed by the

Secondary Care source. A paper copy of the referral will be printed and sent

to the GP with a covering letter referencing the INNU policy.

How can Out-of-Area referrals be sent?

A referral for a hospital outside of your own Health Board is classed as an

Out-of-Area. The WCCG should not be used to send Out-of-Area referrals

directly to other Health Boards. The best way to send an out of area referral is

to send it to the main hospital in your own Health Board, but mark it with the

name of the Out-of-Area hospital, using the ‘INTENDED RECIPIENT’ section

of the referral and entering the out of area hospital in the ‘PREFERRED

PROVIDOR SITE’. An addition al place to put the name of the Out-of-Area

hospital is at the top of the letter (within the ‘CLINICAL DETAILS’ free text box

What is the correct way to mark a referral as Suspected Cancer?

A referral to be marked as Suspected Cancer needs the ‘Priority*’ drop down

option to be set to ‘Urgent Suspected Cancer’ (USC). The hospital aim to

process all suspected cancer referrals within 15 minutes of them being

received. As of July 1st 2014 in ABHB, USC referrals will be accepted via

WCCG with the exception of Oral Surgery & Haematology (South Gwent).


Why should I not use WCCG in Standalone Mode?

There have been reports of referrals being sent successfully via the WCCG

but the event has not been stored back in the patient record. To prevent this

problem, it is advised NOT to use the Standalone version of WCCG.

Does each WCCG referral require a valid NHS Number?

A referral cannot be sent unless a valid NHS number is supplied. If the NHS

number is not known, this may found on the Welsh Demographic Services

(WDS) site. The URL is https://wds.wales.nhs.uk/

If an NHS number is not known, then the user may type 10 characters in the

NHS number field to complete the referral.

How can you add an attachment to a referral?

Files from your GP system can be attached to a WCCG referral. If you use

Docman, there is a dedicated button for this function and the following steps

will not be necessary.

1. Start the referral and click on the ‘Attach’ button at the bottom of the

referral screen.

2. Click the ‘Attach Files...’ button.

3. Navigate to the correct folder and select the patient file to attach. Click

‘Open’.

4. A message box will appear asking you to confirm the upload; click ‘OK’

5. When the upload has completed, click ‘Close’.

To view the attached file, click the paperclip icon that appears next to the referral in

the Worklist.

There is also the ability to use ‘Supplementary Messages’ in Version 15 of WCCG.

To send a supplementary message, locate the original submitted referral in the

Worklist and from the Options box, select ‘Supplementary Message’ from the list.

How do I view a Docman document in WCCG when I get an error message saying ‘No

Preview Available?’

https://wds.wales.nhs.uk/


If a user gets the above message, ensure that MS Picture Manager is used to view

the document. MS Picture Manager is part of the MS Office package.

How do I attach Pathology tests?

For Urgent Suspected Cancer (USC) referrals, please attach ALL relevant

Pathology test results to the referral.

For Routine or Urgent (non-USC) referrals, Pathology test results that have been

processed in your Health Board’s laboratory are available electronically, which

clinicians in your Health Board have access to so there is no requirement to attach

these pathology results to a WCCG referral. If the pathology test has been

processed in a laboratory outside your Health Board, you will need to attach it as it

will not be available electronically for the clinician. For attaching these, please see

the process as listed above.

When I try to preview a referral letter, I receive an error message relating to a ‘cross-

scripting’ issue. How do I resolve this?

There may be instances where changes need to be made to the Security Settings in

Internet Explorer. If this cross-scripting error message in encountered the steps are:

Open Internet Explorer

Go to Tools on the menu bar

Go to Internet Options

Click on the Security tab

Click on the Custom Level button

Scroll down the list to find Enable XSS filter

If it is set to ‘Enable’ – please change to ‘Disable’. Click OK to close Internet

Options. If the problem still continues, then please log a call with Service Desk.


COMMON ATTACHMENT TYPES

File Extension Icon File Description Opens with.....

.BMP

Bitmap image Windows Paint

.DOC or

.DOCX

Word document Microsoft Word

.GIF

GIF image Windows Paint or Image Viewer

.HTM or

.HTML

HTM/HTML document Internet Explorer

.JPG or .JPEG

JPG/JPEG image Windows Paint or Image Viewer

.PDF

Adobe Acrobat file Adobe Acrobat

.PNG

PNG image Windows Paint or Image Viewer

.RTF

Rich Text Format File Microsoft Word or Wordpad

.TEXT or .TXT

Text file Notepad

.TIFF

TIF/TIFF image Windows Paint or Image Viewer

*PowerPoint Presentations (.ppt) or files greater than 5Mb cannot be attached.


REFERRALS VIA POWYS COMMISSIONING

Option 1 – Referrals to English Trusts

Step 1 – Select ‘PtHB’ from the list of Health Boards

Step 2 – Select the Powys tHB Commissioning (English Trusts)

Step 3 – Select the required ‘English Trust’ from the drop down list

Step 4 – Select the Speciality from those available.

The referral will be received at Powys tHB commissioning team where it will be

printed off and actioned accordingly.

The Status of the referral will be updated informing the GP that it has been accepted

and where it has been redirected.


Option 2 – Referrals to Welsh Trusts

Referrals to Welsh Health Boards (only those that are being managed by the

commissioning team

Step 1 – Select ‘PLHB’ from the list of Health Boards

Step 2 – Select the Powys LHB Commissioning (Welsh Trusts)

Step 3 – Select the required ‘Welsh Health Board’ from the drop down list

Step 4 – Select the Speciality from those available.

The referral will be received at Powys tHB commissioning team where it will be

printed off and actioned accordingly.

The Status of the referral will be updated informing the GP that it has been accepted

and where it has been redirected.


HEALTH CARE ENTITIES & THEIR SERVICES

Service Location

Accident & Emergency Shrewsbury & Telford Trust- via Commissioning

Allergy Shrewsbury & Telford Trust - via Commissioning

Anaesthetics Shrewsbury & Telford Trust - via Commissioning

Audiology Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Audiological Medicine HDHB Referral Management (North GPs only) Ystradgynlais Community Hospital

Bladder/Bowel Dysfunction Broddyfi Community Hospital Llanidloes War Memorial Hospital Powys Contact Centre Ystradgynlais Community Hospital

Blood Test Clinic Ystradgynlais Community Hospital

Breast Clinic HDHB Referral Management (North GPs only)

Breast Services Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Cardiac Physiology Shrewsbury & Telford - via Commissioning

Cardiology Breconshire War Memorial Hospital HDHB Referral Management (North GPs only) Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Cardiothoratic Surgery Shrewsbury & Telford Trust - via Commissioning

Chemical Pathology Shrewsbury & Telford Trust - via Commissioning

Clinical Cytogenics and Molecular Genetics Ystradgynlais Community Hospital

Clinical Immunology Shrewsbury & Telford Trust - via Commissioning

Clinical Microbiology Shrewsbury & Telford Trust - via Commissioning

Clinical Neuro-physiology HDHB Referral Management (North GPs only) Wye Valley NHS Trust - via Commissioning

Colonoscopy Breconshire War Memorial Hospital

Colposcopy Llandrindod Wells Hospital


Colorectal Surgery Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Community Paediatrics Ystradgynlais Community Hospital

Day Hospital Ystradgynlais Community Hospital

Dental Medicine Specialties HDHB Referral Management (North GPs only) Wye Valley NHS Trust - via Commissioning

Dermatology HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Victoria Memorial Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Diabetes Powys Contact Centre Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Dietetics Wye Valley NHS Trust - via Commissioning

Diagnostic Imaging Shrewsbury & Telford Trust - via Commissioning

Doppler Clinic Ystradgynlais Community Hospital

Endocrinology HDHB Referral Management (North GPs only) Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

ENT Breconshire War Memorial Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Victoria Memorial Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Gastroenterology HDHB Referral Management (North GPs only) Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Gastroenterology (Gen Meds) Powys Contact Centre

Gastroscopy Breconshire War Memorial Hospital Llandrindod Wells Hospital


General Medicine Breconshire War Memorial Hospital Broddyfi Community Hospital HDHB Referral Management (North GPs only) Llanidloes War Memorial Hospital Ystradgynlais Community Hospital ABMU Health Board - via Commissioning

General Medicine (Breath Test) Broddyfi Community Hospital Llanidloes War Memorial Hospital

General Surgery Breconshire War Memorial Hospital Broddyfi Community Hospital Builth Wells Cottage Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Llanidloes War Memorial Hospital Montgomeryshire County Infirmary Victoria Memorial Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Geriatric Medicine Breconshire War Memorial Hospital Broddyfi Community Hospital Bronllys Hospital Brecon Montgomeryshire County Infirmary Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Geriatric Medicine Falls Breconshire War Memorial Hospital Ystradgynlais Community Hospital

Geriatric Medicine (Parkinsons) Broddyfi Community Hospital

Gynaecology Breconshire War Memorial Hospital Broddyfi Community Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Llanidloes War Memorial Hospital Montgomeryshire County Infirmary Victoria Memorial Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Haematology (Clinical) Breconshire War Memorial Hospital HDHB Referral Management (North GPs only)

Haematology (Non Clinical) Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning


Heptology ABMU Health Board - via Commissioning

Medical Oncology Llanidloes War Memorial Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning

MOTS Clinic (Muscular-Skeletal Triage) Knighton Hospital

Neonatal Shrewsbury & Telford Trust - via Commissioning

Nephrology HDHB Referral Management (North GPs only) Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Neurology HDHB Referral Management (North GPs only) Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Neurosurgery HDHB Referral Management (North GPs only)

Obstetrics (for patients using a bed) Llanidloes War memorial Hospital Montgomeryshire County Infirmary Victoria Memorial Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Obstetrics & Gynaecology Shrewsbury & Telford Trust - via Commissioning ABMU Health Board - via Commissioning

Opthalmology Breconshire War Memorial Hospital Broddyfi Community Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Llanidloes War Memorial Hospital Powys Contact Centre Victoria Memorial Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Opthalmic Nurse Broddyfi Community Hospital Llandrindod Wells Hospital Llanidloes War Memorial Hospital

Oral & Maxillo Facial Surgery Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Oral/Maxillo Facial Surgery Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning


Oral Surgery Breconshire War Memorial Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital

Orthodontics Breconshire War Memorial Hospital

Orthoptics Shrewsbury & Telford Trust - via Commissioning

Orthotics Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Paediatric Orthamology Shrewsbury & Telford Trust - via Commissioning

Paediatrics Breconshire War Memorial Hospital Broddyfi Community Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Llanidloes War Memorial Hospital Montgomeryshire County Infirmary Victoria Memorial Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Pain Management HDHB Referral Management (North GPs only) Shrewsbury & Telford Trust - via Commissioning

Physiotherapy Shrewsbury & Telford Trust - via Commissioning

Plastic Surgery Shrewsbury & Telford Trust - via Commissioning ABMU Health Board - via Commissioning

Podiatry Wye Valley NHS Trust - via Commissioning

Prostate Nurse Clinic Llanidloes War Memorial Hospital Powys Contact Centre Ystradgynlais Community Hospital

Radiology Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Respiratory Broddyfi Community Hospital Powys Contact Centre Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Respiratory Nurse Powys Contact Centre


Rheumatology HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Speech & Language Therapy Shrewsbury & Telford Trust - via Commissioning

Sigmoidoscopy Breconshire War Memorial Hospital Llandrindod Wells Hospital

Stoma Care Llandrindod Wells Hospital

Stroke Medicine Shrewsbury & Telford Trust - via Commissioning

Thoracic Medicine Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning

Trauma & Orthopaedic Breconshire War Memorial Hospital Broddyfi Community Hospital HDHB Referral Management (North GPs only) Llandrindod Wells Hospital Llanidloes War Memorial Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Urodynamics Broddyfi Community Hospital Powys Contact Centre Ystradgynlais Community Hospital

Urology Breconshire War Memorial Hospital Bronllys Hospital HDHB Referral Management (North GPs) Llandrindod Wells Hospital Ystradgynlais Community Hospital Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning ABMU Health Board - via Commissioning

Vascular Surgery Shrewsbury & Telford Trust - via Commissioning Wye Valley NHS Trust - via Commissioning