Community Referred Radiology Contract

This document provides referring practitioners details of the parts of the Community Referred Radiology Contract (CRRC) that are provided by CRG.

These include:

Ultrasound scans (excluding maternity)
CT Colonograms
CT scans of other areas.

The CRRC has been in effect merged with the Acute Demand Contract in terms of the funding, although the referral processes remain distinct.

Bookings

To book these examinations under the CRRC, all requests should be faxed to CRG Community-Referred Contract Bookings on: 371 7200. Please use the specific CRRC referral form or modify your computer forms to look like it.

Purpose of the CRRC

The purpose of the CRRC is to provide citizens with appropriate access to xrays and scans without having to attend a public hospital.  

Eligibility Criteria for CRRC cases:

Referrals will only be accepted from private practitioners, and patients from general practitioners will receive priority

Any likely potential pathology, based on the clinical evidence, must be of sufficient significance to qualify for treatment at ChCh Hospital under prevailing hospital acceptance criteria.

Procedures funded from other public sources (eg ACC, Maternity) will be excluded.

Clinical Guidelines:

Guidelines are now available on the Health Pathways site.  Note that some of the allowed investigations on that website may differ from what have been available previously.

For cases that do not fit into the guidelines, other management options to be considered include:

Referral to a hospital clinic for first specialist assessment.
Discussion about alternatives with a clinical specialist.
Private radiology referral to Christchurch Radiology Group (or other provider).

Ultrasound Scans
Please note the following clinical guidelines:

For heavy or irregular menses, priority will be low except where the referral indicates one of the following risk factors:

Nulliparous
Infertile
> 45 yrs old
weight > 90 Kg

For follow-up of ovarian cysts etc, a repeat scan will not be performed less than 3 months after the initial scan unless symptoms deteriorate.

Automatic exclusions include:

Referrals from Hospital Specialists or Hospital Clinics.
All paediatric exams under 12 months of age (including US hips). Referrals should be sent to ChCh Hospital for approval.
Musculo-skeletal Ultrasound - includes all joints, tendons, non-tender cutaneous and subcutaneous lumps, and for diagnosing hernias as a cause of otherwise unexplained groin pain - these are currently under review, and it is not clear whether thesew will be funded or not.
Carotid and other arterial Doppler US
US Veins for chronic venous insufficiency
Screening Exams where there no symptoms (such as for family history of ovarian cancer)
Scans that are clinically urgent and need to be performed within 3 working days of receipt of the referral form. These patients however may well be eligible for funding under the Acute Demand Contract.  If not, then should be referred to ChCh Hospital Emergency Department.

Barium Enemas and CT Colonography

Barium enemas are nolonger performed and have been superceded by CT Colonography

Automatic exclusions include:

Referrals from Hospital Specialists or Hospital Clinics.
Where there are no symptoms or signs of colon cancer
Family history of Colorectal CA, without symptoms or signs, does not qualify

CT Scans

These may be for any area of the body, so long as a radiologist agrees the clinical justification. This could be either by the referrer phoning a radiologist or by the radiologist triaging the faxed referral form.

Acute CT Scans: There will be limited availability for acute scans referred by general practitioners (ie within 3 working days after receipt of the referral, and these will be for:

Acute renal colic, where symptoms require analgesia or there is evidence of urinary tract infection
Acute brain syndromes or severe headache where ongoing care is likely to remain in general practice.

Cases that are more acute may be able to be handled under the Acute Demand Contract.

Automatic Exclusions for any CT scanning include:

Referrals from Hospital Specialists or Hospital Clinics.
CT for neck or back pain in the absence of symptoms, signs or other tests suggesting possible malignancy.
CT for haematuria - these all need referral to a Urologist (public clinic or privately).
CT Sinuses
Ultrasound Thyroid

General Xrays:

These are performed exclusively by CMI
Fax all referrals to 375 4059

Other Radiology Exams

Please note that MRI, Mammography, Barium Meals and Hysterosalpingograms, among other things, are not currently available under this contract. However CRG is more than happy to perform them on private referral.

Referral Form:

Please use the specific CRRC referral form or modify your computer forms to look like it.

Please note: Ethnicity is required by the Ministry of Health

Triage and Bookings:

Triage is a vexed topic. For many procedures covered by the Community-Referred Contract, triage is performed by staff at CDHB. These cases include US female pelvis and CT Colonography.  For other cases, on receipt of the referral form CRG will assess the case for eligibility using the criteria in this document. Those deemed to be ineligible will be returned immediately to the referrer.

If eligible, each case is given a clinical grading that includes the level of urgency and significance of any likely pathology. The quality of the clinical information on the referral form is important to help us make the correct decision.

Urgent cases will be booked within the next 3 working days. If no bookings are available, they will be returned to the referrer to make other arrangements (such as hospital admission or referral under the Acute Demand Contract). They will not just revert to the non-urgent list, unless that is deemed acceptable by the referrer.

Routine cases will be booked within 8 weeks of the date of receipt of the referral. The clinical grading will determine the priority of booking. If the 8 week target cannot be met, the referrer will be informed and the request form returned.

Note that under the new Health Pathways guidelines, it is anticipated that in time all triaging will be performed centrally by the referral team at CDHB.  The mechanism for this is currently in transition, therefore in the interim some referrals sent to CRG may be forwarded on to the triage tream at CDHB