• A referral should be made when the implemented treatment plan, based on a holistic wound assessment, is not achieving the desired outcomes.
• The clinician is expected to of followed the relevant frameworks in place prior to a referral and to have discussed the treatment plan with a senior clinician within their team.

Pressure ulcers

1. Category 3 and above to support assessment and management if specialist advice needed.
2. Lateral turning system authorisation
3. Complex symptoms such as infection, pain or exudate.

Leg ulcers

1. Management: Leg ulcers that have failed to progress following 12 weeks of optimum treatment.
2. Complex symptoms such as varicose eczema, hyperkeratosis, pain and exudate.

• Lymphoedema: If active leg ulceration.
• MASD: Severe if failing to resolve following MASD pathway.
• Advanced therapy, such as NPWT or Larvae therapy, tissue viability will provide education and support.
• Non-healing surgical wounds.
• Referrals from podiatry for foot ulceration.
• Fungating wounds: Complex symptom management.

• If the patient is already under another specialist service, then contact should be made with them in the first instance.
• Pressure ulcer: Category 1 and 2
• Ordering equipment.
• MASD: Prevention, mild and moderate.
• NPWT: Routine referrals, acute trust issued, unless clinical or training reason.
• Oedema management
• Lymphoedema
• Dermatological conditions
• Foot ulceration: Anything below the malleolus is to be referred to podiatry.