Within the Social Rx system, the pathway of socially-prescribed individuals can be managed.
View a Case
When you log in to your Social Rx account, you will be taken straight to the Caseload Dashboard. To view an individual case, simply click the 'View Case' button on the left-hand side (yellow circle below labelled '1') , or the pencil icon in the third to last column (yellow circle labelled '2').
Manage a Case
Once you have opened the patient's case, you will be able to see the Referral Management page. The top banner shows the key patient information including name and phone number. Here you can view and edit the status of the patient by clicking the button ‘Status’ (yellow circle below labelled '1'). Clicking the button again then collapses this section. Next to this are the Case Notes which can be viewed and added to by clicking the button. Any known patient risk factors will also be stored in the top banner, via the red triangle (yellow circle below labelled '2'). If you click the red triangle, you will be able to view the risk factors and add any others, by clicking the 'Add Risk Factor' button (yellow circle labelled '3').
The ‘GP Link’ button (yellow circle below labelled '4’) shows when a case is linked with a GP system. By clicking the button, you can see which system the case is linked to. You can change the ‘Share All Data’ toggle to ‘No’, for example if your patient isn’t comfortable with their data being shared with the GP. In this case, only SNOMED codes will be sent into the GP system.
The ‘Safeguarding’ button (yellow circle below labelled '5’) allows you to view any safeguarding incidents that have occurred or record any new incidents. Note that this button can be turned on or off by the Local Admin in the ‘Customer Configuration’ section.
Also in the top banner, you can add tags to the patient’s case (yellow circle below labelled '6’). This is flexible and allows you to add any tag that you’d like. For example, you may wish to tag each case with a RAG rating, whereby ‘RAG rating’ is the tag category, and ‘Red’, ‘Amber’ and ‘Green’ are the tags. To add a tag, select ‘Add Tag’ at the top of the patient’s case. You can select the tag category and then the tag, adding a note to the tag if necessary. To remove a tag, click on it and then select ‘Remove Tag’. New tags are created by users who hold admin permissions.
Finally, a ‘Linked Cases’ button will appear in the patient precis if the case is linked to another case within Social Rx. This may be if the same person has been re-referred into social prescribing. On clicking the Linked Cases button, you can view the list of linked cases and click to go into any of the linked cases. At the point of referral, if there is an existing case with the same NHS number or the same surname and date of birth, the referrer can choose to link the cases.
Below you can see the Referral Management Pathway, starting with 'Referral Detail' and ending with 'Discharge'.
Review Referral Details
The first icon in the Referral Management screen’s pathway labelled ‘Referral Detail’ shows 7 sections, allowing you to do the following.
1. View Referral information
This section allows you to view the initial referral information.
2. Capture Equal Opportunities Data
Here you can capture data such as gender and age group. This section is configurable so you decide exactly what data is collected.
3. View and add attachments
This section allows you to add, view and remove attachments.
Click ‘Choose file’ to browse a file on your computer, and choose the file you wish to attach. Once you’ve chosen a file, press the ‘Attach’ button as shown in the screenshot above. The file will be shown in the table and you should see a confirmation stating ‘Uploaded. Thank you’.
4. Update consent (Local)
This section allows you to update the consent model information if this is a requirement.
5. Accept or Reject
This section allows you to accept or reject the patient referral. You can either click the 'Accept' button (yellow circle labelled '1') or select a reject reason and click the 'Reject & Discharge' button (yellow circle labelled '2').
When you press the Reject & Discharge button, the status of the patient will be changed to Discharged. If the patient was referred in from EMIS, a message will be sent to EMIS to notify them that the patient declines social prescribing (including the SNOMED code - 871711000000103).
6. Update Link Workers and Participants
To the right, you should see a button that says ‘Update Link Workers and Participants’. This section allows you to choose an organisation and a person and assign them as a Link worker. Make sure to click ‘Save’ before you leave this screen.
7. Toggle to say Section complete
This toggle button lets you mark the section as complete. This can be toggled on and off at any point in the pathway to support the operational needs.
The toggle button is available for the below subsections in the Referral Management screen as well.
Schedule appointments
The second icon in the Referral Management screen’s pathway labelled ‘Schedule Appointment’ allows you to carry out two tasks: scheduling activities and entering communication notes. Click on the calendar icon
to enter this screen.
Schedule activities
You can schedule activities such as the first task planned or a follow up assessment call.
Step 1: Click Add activity (yellow circle above labelled ‘1’), this will give you a popup to add a new activity.
Step 2: Select communication type, schedule date time, assign to yourself or someone else and tick if you want a calendar reminder sent to your diary.
Step 3: Click save; this will add the activity to the list.
Step 4: When necessary, click the complete button on the left-hand side.
Step 5: Update the information, including the time taken to carry out the activity if you want.
Step 6: Click ‘Save’.
Communication notes
Communication notes can include any information about the progress of the patient through social prescribing.
To add a communication note to the patient record, click the 'Communication Notes' tab (yellow circle above labelled ‘2’).
Step 1: Click 'Add communication', this will give you a popup to add a new activity.
Step 2: Enter the communication information including the time taken and press ‘Save’. This will save the information in the grid below the fields.
Step 3: Optionally update the status
Step 4: Press close to close the popup.
Baseline Assessment
The third icon in the Referral Management screen’s pathway labelled ‘Baseline Assessment’ allows you to record the baseline assessment via (but not limited to):
1. Health and Wellbeing Prism (H & WB Prism)
2. Patient Activation Measure® (PAM®)
3. Shortened Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS)
4. Office of National Statistics 4 (ONS4)
Step 1: Optionally, you can select whether or not assessments are suitable for the patient. If you select 'No', you can input a reason which can be used for reporting purposes.
Step 2: To enter an assessment, click on the baseline assessment name (e.g. 'H&WB Prism’; see screenshot above). This will show any existing assessments already done.
Step 3: If a grid of questions does not appear, click on the ‘+ New’ button to the right. This will show the questions that can be answered.
Step 4: Fill out the form based on an individuals’ answers and click on the ‘Save’ button. This will save the latest assessment and the graph will show the last, the very first, and the most recent assessment.
Step 5: Click on the other baseline assessment names as required and follow the above steps to answer the questions and add information on patient outcomes.
Action Plan
You can add action plans by tapping on the
icon, labelled ‘Action Plan’. Again, you can select whether or not the Action Plan is suitable for a patient.
Personalised Wellbeing Plan
The first tab, ‘Personalised Wellbeing Plan’, is configurable so that as a link worker, you can determine what information is collected in this section. Note that the plan is edited by a user with admin permissions. Add a Personalised Wellbeing Plan by filling out the form, then press ‘Save’ to save a version of the plan.
Plan History
By tapping on ‘Plan History’, you can view all of the previous Personalised Wellbeing Plans. It says either ‘No records’ or a grid is shown for all the past plans. Click on 'select' to see the past plans.
Conversation Records
Conversation Records provide a way of recording patient information of specific themes, such as hobbies, financial concerns or emergency contacts.
Step 1: Tap the ‘Add Conversation’ button.
Step 2: Select a Conversation Theme from the list to the left and add free text information, such as what was discussed. Press Save.
Step 3: Information with date, time and logger is added to a historical grid. Press ‘Delete Record’ to remove any records. Please note that these are archived and available for audit.
Services
The fifth icon in the referral management pathway is for referring a patients to a service, and is accessed through the button labelled ‘Services’. If there are already bookings made for this patient, they will be stored in a grid under the word 'Bookings', with details of the booking including location, status and date (yellow circled below labelled '1').
When you want to make a new booking;
Step 1: Click on the ‘Add Booking’ button (yellow circle above labelled '2').
Step 2: If you already know where you want to refer your patient, you can do a 'Quick Search' by typing the name of the service site in the search box, and selecting the right one. Alternatively, you can search for an appropriate service by first clicking on 'Advanced Search'. You can search by service type (eg. 'Advice' in screenshot below) by selecting a service from the drop-down filter (yellow circle below labelled '1'). You can also add the patient's postcode (yellow circle below labelled '2'), which allows you to see where each service is in relation to the patient's home, on the integrated Google Maps section. When you click on the service, you will see how many miles away it is from the patient's postcode. If you want to book that service, click the 'Select This Site' button.
Step 3: Now you will be able to see the site information including opening times and facilities if they have been inputted into the system (see folder 'Directory of Services' for more information). Here you can add any booking notes and select the specific service that you want (eg. bereavement counselling below).
Step 4: You can select whether or not the patient is happy for the service provider to contact them, and if you want to send an automatic email to the service provider or not. You may wish not to if you prefer to ring them, or if you only wanted to signpost the service to a patient, for example.
Step 5: Click on ‘Book Referral’ if satisfied or ‘Cancel’ if you wish to choose a different site.
To manage information on service providers, please see section 'Directory of Services'.
Follow up Assessment
Click on the
button to access the Follow up Assessment section. Here, you can:
- Add any number of follow-up meetings by clicking on the 'Add New Follow up Date' button. These meetings are then added to the 'View Scheduled Tasks' section.
- View and update assessments
- View the plan history
- View and update conversation records
See previous paragraph 'Baseline Assessment’ on how to manage these items.
Discharge
The final section on the referral management pathway is where you can discharge your patient. Depending on your social prescribing programme, you may want to carry out an Outcome Report, which reports on the overall outcome outcome for the patient, and any comments they have. This section is configurable, allowing you and your team to capture exactly what information you need. You can fill this form out by selecting from a dropdown menu or typing into a text box. Once ready, press ‘Save’.
The tab 'GP Letters' allows you to send a letter to a GP and other appropriate parties if automatically connected to EMIS or SystmOne. You can also upload documents here to be sent to the GP by selecting 'Choose File' and then selecting the attachment you want to send.
The final tab, 'Status', shows an overview of the logged status, and allows you to update it. To update, click on 'New Status', then select from the drop-down menu. If you select 'Declined', 'Discharged' or 'On Hold', you will be asked to select a reason. Then, you can click 'Update' to update the patient status.
Video Overview - Managing A Case
Watch our video guide of managing a case from referral to discharge here: