Unscheduled care - professional to professional decision support: guidance

This best practice guidance will help effective clinical communication and support shared decision making, with the aim of accessing alternatives to hospital attendance or admission where appropriate and safe to do so.

Clinical Governance

Individual health board clinical and corporate governance arrangements would apply to activity undertaken as part of the professional to professional decision support approach. This does not impact on the pre-existing governance arrangements in health boards regarding split of responsibility for a patient between clinicians. It is important that patients are kept informed and updated about the decisions related to their care, what they can expect to happen next and any safety-netting that is required.

Clinical Governance measures should include:

  • Review of clinical records, ideally including transcription or recording of the professional to professional conversation
  • Regular audit of outcome data
  • Feedback to clinicians, including improvements and shared learning after audit or review

Complaints management and adverse event reviews should be undertaken jointly between organisations. Learning should be shared by both parties and joint improvement, education and training developed.

High frequency monitoring, evaluation and rapid reporting should be undertaken during an implementation period to ensure safety and to respond to any unintended consequences.

Information Governance

Strict adherence to the Caldicott principles and issues of patient confidentiality must be observed. The sharing of information between Health Boards is to be in accordance with the Intra NHS Scotland Information Sharing Agreement (NHS Scotland 2020). A data protection impact assessment (DPIA) should be in place for any new data flows to meet the governance requirements, if required.

Clinical Engagement

There should be a shared understanding of roles and scope of practice, along with shared understanding of professional to professional decision support expectations. Systems should be co-designed, with clearly defined processes and hours of operation.

Some important points for consideration to encourage clinical engagement include:

  • Review and map current pathways, identify gaps and opportunities, widen access and develop ambulatory assessment services
  • Resource the professional to professional decision support service appropriately
  • Consideration should be given to the benefits of incorporating this within the operations of a health board's Flow Navigation Centre as part of the RUC pathway. This guidance can also be used for other settings within primary, community and secondary care services
  • Identify a clinical champion within the organisation to support with engagement and the ongoing delivery and development of the service
  • Establish key stakeholders, engage early and co-design the service
  • Ensure the necessary technical infrastructure is in place to deliver the requirements
  • Ensure the necessary clinical governance arrangements are in place
  • Ensure regular communication at the implementation phase and during the introduction of any new specialties, as well as regular communication with service users e.g. GP localities, ambulance service, etc
  • Establish a clear and structured education and training plan, with ongoing team support
  • Identify, capture and share best practice and support the spread of innovation



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