Abstract

Introduction
Royal Primary Care Chesterfield, is a group of GP practices which serve a population of approximately 50,000 patients, covering areas with the highest rates of social deprivation in Derbyshire. Respiratory patients who would otherwise have been referred to secondary care are managed in a GPwER clinic. I work as part of the community respiratory multi-disciplinary team, attending virtual MDT meetings in which Consultants from Chesterfield Royal Hospital provide clinical oversight.
The audit aims to review the referrals made to Respiratory Medicine from Royal Primary Care Chesterfield before and after the start of the community clinic, to see if there has been any changes in referral rates or appropriateness.

Method
A read code System One search identified patients who had been referred to Respiratory Medicine in the years prior to and since the start of the GPwER clinic in 2023. The years covering the COVID 19 pandemic were not included. Data was collected on the number of referrals, referral location and indication. An assessment was then made as to the appropriateness of the referral, and whether this could now be managed in the community respiratory clinic avoiding a referral.

Results
There has been a significant reduction in the number of referrals to Respiratory Medicine from 71 in 2022 to 30 in 2025 a 57 % decrease since the start of the community clinic.
There is a reduction in referrals evaluated to be inappropriate, from 74% in 2022, to 22.5% in 2025. Over the same time there has been a small increase in the number of appropriate referrals, showing that patients who require a referral are still being referred.

Discussion
The audit has found a significant reduction in the number of referrals to Respiratory Medicine since the start of the community GPwER led clinic. This reflects improved patient diagnosis and treatment optimisation prior to referral. The community clinic provides holistic care in a timely manner, closer to home, meeting the needs of a deprived population who are often underserved by traditional healthcare models. Working within the community MDT has been an opportunity to build strong relationships between Primary and Secondary care.