The single point of access for hernia surgery referrals in NCL has been running successfully since March 2023 and it has been agreed that it will now continue as business as usual. However secondary care clinicians are still finding that they are unable to triage many referrals due to a lack of clinical information. When referring, referrers should make sure that they are using the bespoke EMIS referral template to ensure that all essential clinical information is included, otherwise the referral will be returned.
When referring, GPs should advise their patients that they will be contacted and given an appointment by the trust that is the most clinically appropriate for their surgery. Patients should also have agreed that they wish to explore a surgical option. Some trusts are now offering inguinal hernias under a local anaesthetic so please ask them whether they would consider this as an option if appropriate.
A patient information leaflet to explain the process to patients and ensure they understand that they will be sent to the most appropriate trust is available in the EMIS Global referral folders, from which a link can be inserted into a text, or which can be printed out and given to patients.
There is also a useful decision-making support tool available for GPs to give to patients with inguinal hernias to help them understand their surgical options: Making a decision about inguinal hernia, NHS England.
There is no change to the process for emergency referrals.
Referral requirements
The below clinical information is essential and must be included in any hernia referral.
For all hernias:
- BMI (particularly important for ventral hernias and to ensure that patients are directed to the correct service)
- smoking status
- significant comorbidities (e.g. diabetes)
- previous hernia surgery (and whether open or laparoscopic)
- other abdominal surgery, if applicable
- attach full reports of any scans relevant to the referral (unnecessary for palpable hernias).
For inguinal (groin) hernias:
- findings from clinical examination of both groins
- is the hernia inguinal or inguinoscrotal?
- is the hernia reducible/irreducible?
For inguinal (groin) hernias, ultrasound scans are not needed prior to referral for surgery, unless the hernia is not palpable and there is diagnostic uncertainty.
For ventral hernias:
- site of hernia
- previous surgery (laparoscopic or open especially useful)
- estimated size of defect (i.e. hole in abdominal wall, not size of bulge); if not possible from clinical examination, please arrange ultrasound scan pre-referral.
Referrers are required to use the bespoke EMIS-compatible NCL hernia referral form, which provides prompts/dropdowns and enables importing of key information. It is quick and easy to complete and helps the triaging clinician to triage effectively and direct referrals to the most appropriate trust.
If a completed EMIS referral form is not attached, referrals will be returned to the referrer.
EBICS approval will be made by the surgical team as part of their assessment.
Please note: Within six months of a hernia repair, any post-op complication does not require a new referral. Please send your request for review, with relevant clinical details, directly to the hospital department who carried out the original hernia repair.
