Recall Policy

Code: A1.7-5.1

Date: 17/06/2014 

Reviewed 07/02/2016, 20/04/2021

Purpose:

Recalls:

• Remind staff and clients about important events, usually significantly in the future.

• Assist in the management of national and local screening programmes.

• Provide assurance that important events are actioned appropriately.

Responsible Staff:

Implementation: Senior Practice Nurse

Action: All Staff

Audit: Senior Practice Nurse

Audit:

Training Resources:

Linked Policies:

Enabling Resources:

Policy:

Definitions:

Recall - a timed task set to be completed in a specific time frame, or on a particular date.

Actioned - the patient has been sent an appropriate contact to advise them of the requirements of the recall.

Completed - the action requested in the recall has been performed. (eg:  blood has been taken)

Recalls should be set to remind staff about important events that occur in the future of a patient. They are designed to trigger patient contact and are not intended to be used as a list of overdue examinations.

Recalls are managed by the practice nursing team and recall use should reflect this fact. Sending and contacting patients for recalls is predominantly the responsibility of the practice nurses but all clinicians should accept responsibility for ensuring recalls are actioned where appropriate.

Staff should consider before setting a recall whether this is the most appropriate means of managing the future event. Task manager may be a more suitable means to remind staff to review notes, for example.

Once a recall is set, it must ultimately be actioned. This will involve a reasonable attempt to contact the patient and to offer them the service for which they are being recalled. patients are free to decline to accept the advice but it is our responsibility to ensure that they are aware of the possible implications of this.

Recall letters should provide sufficient resources (or advice about where to find information) to allow patients to make an informed decision.

Phone contact when recorded should include a note as to whether or not the patient appeared to understand the implication of their choice if they are declining the recall.

All staff involved in patient care should accept some responsibility for the management of recalls. Noting the red tab on MT32 and taking action according to this policy is very helpful, minimises nurse recall time and may improve patient outcomes.

Recalls fall into several broad categories:

Category 1:

A significant adverse outcome might be expected if the recall is not actioned in a timely manner.

Eg: blood tests for medication safety or where advised after a consultation or hospital discharge. Early childhood immunisations

Every effort should be made to ensure Cat1 recalls are completed promptly.

Clinicians setting category 1 recalls are responsible for ensuring the recall has been actioned.  It is the job of the nursing team to contact the patient and to arrange any test required, but the requesting clinician needs to ensure these are followed-up.  Setting a task is recommended.

Category 2:

A significant adverse outcome might be expected if the recall is not actioned but the recall is less time sensitive.

Eg: later childhood immunisations, screening blood tests for MGUS, Smears for higher risk patients.

Generally once completed, there is no need for a task to be set.

Category 3:

A significant adverse outcome is unlikely if the recall is not actioned but the patient may not gain the benefit expected from the recall:

Eg: National and local screening recalls, smears, mammograms, colonoscopies, routine healthcare checks, later adult immunisations, travel vaccine recalls.

Category 4:

Administrative recalls of little or no clinical significance.

eg: Reminders for checking visa status

Handling recalls:

Recall management is the responsibility of the lead practice nurse.

At least once per week, the recall list shall be checked by the lead practice nurse or their nominated deputy. Responsibility for oversight of recalls rests with the lead practice nurse.

1. Check the next 7 days and action all recalls due in this period.
2. Check the previous 7 days for Category 1 recalls that may not have been completed.
3. Check 28 days ago to 21 days ago for any recalls that may not have been completed.
4. Check 6 months and older and action all recalls older than 6 months.

Once actioned, the recall is left in place on the record until completed.

When the action associated with the recall has been completed, the recall should be deleted or re-set to the appropriate time frame if it has a cycle time associated with it.

If a recall cannot be completed in an appropriate time frame, the requesting clinician should be informed by a task.

Some specific recall items have their own attached follow-up process. Where there is no specific direction, follow the appropriate guidance for the general category into which the recall falls. If the category is uncertain, it should be assumed to be in the higher rather than the lower category.

Category 1:

The patient should be contacted appropriately. This may be by letter or txt in the first instance but recalls that are more than 1 week overdue require a genuine attempt to telephone the patient, speak to them and ensure they are aware of the importance of having the test done and an appropriate timescale agreed.

Category 2:

Patients will usually be aware of the need for these tests. A reminder letter or txt should be sent if appropriate. If the test is one month or more overdue, a genuine attempt should be made to contact the patient by phone.

Category 3:

Patients can be expected to take responsibility for non-response to recall contacts. Opportunistic discussion is important when these recalls are delayed.

Category 4:

These are varied in their nature and are handled according to relevant protocols or common sense. Where there is uncertainty, refer to the Practice Administrator or reception staff for administrative recalls and to the Clinical Director for clinical recalls.

Specific Recall Processes:

Cervical Smears.

A letter should be sent when the smear is due.

If, after 2 months there has been no response, an attempt should be made to contact the patient by telephone and/or txt.

If the patient explicitly declines screening, the recall should, with the patient's consent, be reset to 3 years in advance of the date of declining, otherwise it should be deleted and the reasons noted.

If contact cannot be made by phone or txt, send an overdue smear letter, reset the recall to 1 year in advance and set an alert to advise staff that a smear is overdue.

Childhood Immunisations.

Every effort should be made to contact the responsible caregiver. Efforts should be documented.

If immunisation is actively declined, a note of this should be made.

If contact cannot be made, or the child is not brought to care, refer to outreach promptly.

If a decision is deferred, reset the recall to a mutually agreeable recall time.

Set an alert to notify staff that an immunisation is overdue (and which one)

Adult Immunisations.

A single letter of recall should be sent.

If there is no response, leave the recall active and action opportunistically up to 6 months overdue. After 6 months, set an alert and delete the recall.

Where the vaccine is no longer appropriate (eg second Hep A more than 2 years after first) delete the alert.

Mammograms.

 Mammography is managed by the national breast screening service.  The purpose of recalls is to trigger a conversation with women who may be choosing not to go any more.  Nursing staff should contact women more than 6 months overdue for a mammogram and see if there is any support they require to participate in screening.

Annual Health Reviews

A single letter should be sent.

If the client does not respond and has had a check in the last 2 years, reset to one year hence otherwise delete the recall.

Recall Letters

The recall letters are of necessity evolving with time and to suit or patients' needs.

Staff who have suggestions for changes to recall letters should in the first instance discuss the matter with the Clinical Director.

Staff should not change recall letters without reference to the Clinical Director.

Changes to letters should be notified to all staff to allow comment and improvement.

Change Log

07/02/2016

No Changes

16/07/2014

Significant word changes and grammatical improvements.  Requires staff to re-familiarise.

20/04/2021

Addition of definitions, addition of recall process for clarity, clarification of responsibilities for recall management and follow-up.

Minor grammar improvements.

21/01/2022

Modified action for mammography recall to reflect change to national agency.