FOI 2026/1730

I request, under the Freedom of Information Act (2000) the following information from both TGH and GM ICB:

Context:

It has come to my attention that GPs in Ashton-u-Lyne are advising patients they are unable to refer individuals to fracture clinics directly. Even though they have been assessed and treated in hospitals outside of the area.  For example, if someone with a Tameside GP in Ashton-u-Lyne sustains a fracture on holiday (in the UK or outside of the UK) and have been assessed with clear discharge paperwork and up to date scans, they are currently unable to receive timely follow up care in their locality.

GPs in Ashton-u-Lyne (5 practices that I am aware of up to now) are telling people in such situations, that the only way they can get support is to attend A and E, spend as long as they need to there (which, given a lot of these instances are not life threatening, could be for a considerable amount of time), to undergo unnecessary further assessment and X-Rays, in order to be referred for ongoing treatment and care. Treatment that has already been assessed and commenced in another hospital, NHS or other.

Can you please provide:

1. Confirmation as to whether GPs in Ashton-u-Lyne are unable to refer patients to fracture clinics directly when they return home, after suffering an accident on holiday, despite these being assessed and diagnosed, with ongoing treatment and assessment needs identified from out of area hospitals, including NHS providers.
2. If this is in place, is it localised to Ashton-u-Lyne, Tameside or GM as a whole?
3. If this pathway (or lack thereof) is currently in operation, what is the clinical rationale for this decision and which group/service made it?
4. What date did this decision come into effect?
5. Please provide any meeting minutes where this was discussed and agreed.
6. Please provide monitoring/governance measures that are in place around this decision.
7. Please provide details pertaining to whether the risks around the effects of exposing patients to multiple, unnecessary scans and delays in treatment are being recorded, mitigated and considered.
8. Is this process reflected on any risk registers trusts/services hold? If so, please provide the details of these.
9. Please provide details as to how this use of the public purse is justified by duplicating interventions and sending patients to A and E, when they have already been through the process out of area.
10. Are GPs in Ashton-u-Lyne restricted in referring to any other departments that are needed, if individuals return from holiday are in need ongoing treatment, for a physical health event that happened whilst away? For example, if they had a heart attack and needed to be referred to cardiology on their return, would they be required to go to A and E again as well?
11. Details of any impact on A and E waiting times as a result of this process.
12. Have there been any patient safety incidents, that identify this process as a contributing factor. If so, how many have there been since this processes was implemented and what have they been graded as in terms of Actual Impact.
13. Have there been any learning responses under PSIRF that identify this process as a contributing factor? If so can you provide the details of any learning and escalation that occurred as a result of these investigation.

I have also copied in Angela Raynor, MP for Ashton-u-Lyne, and the other MPs for Tameside. I wish to make them all aware of this alarming breakdown in patient pathways and care, and the additional pressure that is being applied to already buckling urgent care systems, for want of a logical approach.

1. The established referral route into the Fracture Clinic is via the Emergency Department, which provides a safe and standardised point for clinical triage, assessment and initial management of suspected or confirmed fractures.

This applies regardless of where the original injury occurred or where the initial assessment or diagnosis took place, including NHS hospitals outside the local area.

For patients with established or ongoing orthopaedic conditions following initial emergency management, GPs in Tameside have access to alternative referral routes via two Referral Assessment Services (RAS) and Advice & Guidance (A&G) pathways into Tameside and Glossop Integrated Care NHS Foundation Trust. These routes provide access to specialist advice and assessment but do not constitute direct referral into the Fracture Clinic.

2. This applies to all of Tameside.
3. Please refer to the response to question 1.
4. NHS GM does not hold the information requested; therefore, it will be necessary for you to contact the Trust directly for the information you seek. To assist you please find below a link to the Trust’s website and how to make a Freedom of Information request.

Freedom of Information Requests :: Tameside and Glossop Integrated Care

5. Please refer to the response to question 4.
6. Please refer to the response to question 4.
7. Clinical decisions regarding assessment, repeat imaging and onward referral are made by appropriately qualified clinicians based on individual patient presentation and clinical need.

Repeat imaging or reassessment may be required in some circumstances, including where prior imaging is unavailable, cannot be verified in a timely manner, or where the patient’s clinical presentation has changed.

The ICB does not hold records of individual clinical decision making or patient level risk assessments, which sit with provider organisations. As such, we cannot comment on individual clinical cases within the scope of this request.

8. Please refer to the response to question 4.
9. Please refer to the response to question 4.
10. This is entirely dependent on the persons presentation and the associated clinical decision making. In general terms if there is a new, severe or worsening problem A&E may be the most appropriate route as opposed to ongoing, stable issues that require GP referral.
11. 12. & 13. NHS GM does have access to high level Emergency Department performance; however, we do not hold detailed and in-depth information or analysis on Emergency Department waiting times, patient safety incidents or PSIRF investigations arising from provider operational processes. This information is held by the relevant provider organisation. Therefore, it will be necessary for you to contact Tameside and Glossop Integrated Care NHS Foundation Trust, which is responsible for Emergency Department and Fracture Clinic services, for the information you seek. To assist you please find below a link to the Trust’s website and how to make a Freedom of Information request.

Freedom of Information Requests :: Tameside and Glossop Integrated Care