Providing the Correct Health Care within the Public Health Service

In order to ensure that urgent care is given to patients in need, both staff and the public should be aware of the correct procedure for referring patients to the most appropriate level of care, at the same time ensuring such referral will bring the patient closer to their place of residence within the Western Cape.

This includes:

Minor illness or injuries are treated at Primary Health Care facilities such as a Clinic or a Community Health Centre (CHC). This should be the patient's first entry point into the public health service as many services are offered. A specially trained nurse will treat the patient and refer you to a doctor if your condition requires it.

More serious conditions are referred to the next level of care which is a District Hospital. Should the patient's condition need further investigation or intervention, the nurse or doctor will make an appointment for them at the District Hospital closest to their home.

Western Cape Minister of Health, Theuns Botha, said: "A large number of complaints and problems at health facilities arise as a result of the poor understanding of our referral system. Patients often spend many unnecessary travelling and waiting hours because they are unaware of our referral route. Adherence to the referral system will greatly lighten the workload at our respective facilities - be it a community health centre or hospital - and improve the patient experience."

If the District Hospital is unable to provide the necessary treatment, the doctor will refer the patient to an appropriate hospital, which offers a higher level of care.

When a patient is referred to a different hospital or clinic, the health carer will provide them with a letter of referral and an appointment date. A letter of referral tells the doctor about the care the patient has already received. It is important to keep these documents together in a safe place and patients need to take them along to their next appointment.

It is only on certain conditions that a patient can be referred i.e. complications, high risk diseases, x-rays and results, scanning, acute injuries (where a patient must see a specialist) and on situations where a general practitioner doctor or family physician is no longer able to help a patient.

The Western Cape Department of Health encourages the public to make the primary health care facilities their first port of entry into the public health system. However, there are instances where the public bypass the referral route and present themselves to hospitals directly, without the necessary referral letter. It is very costly to government to provide health care to someone at a hospital who could have received the same treatment at a primary health care facility closer to their home.

When patients present themselves at a District, Regional or Tertiary Hospital, they are assessed, triaged and if found that they are able to receive the necessary treatment at a clinic or CHC they will be referred back to the primary health care facility closest to their home.This enables follow up on discharge, with feedback to the clinics, continuous support for primary level staff in the management of patients and a mechanism to ensure the patients do not get lost in the health care system for follow-up.

All clinics have access (by referral or by periodic clinic visits) to specialist mental health expertise (psychiatrists, psychologists, occupational therapists) and social workers from district or regional level at least once a month.

Issued by:
Directorate Communications
Western Cape Department of Health