Cinapsis SmartReferrals is an app-based platform designed to boost collaboration between primary and secondary healthcare workers.
The initiative has been adopted by a number of NHS organisations in efforts to reduce waiting times, minimise A&E referrals, improve communication and enable shared decision making between disciplines.
Dr Owain Rhys Hughes was motivated to develop the app while working as an NHS ENT specialist.
“I would often see patients in outpatients who really didn’t need to be there,” Owain says.
“Probably the most acute example of this was when I was working in a cancer centre.
“Patients would be referred on a two-week wait suspected cancer pathway. But it was pretty obvious, as soon as I read the GP’s referral letter and had a very brief conversation with the patient, that they were very unlikely to have cancer, they’re on the wrong pathway.
“I would also see ENT patients who were expecting that they would need an operation. And, when I explained to them that they needed more tests and some trial medication, they would be upset because they had been mentally preparing for that operation. And in all that time, they hadn’t started any treatments.”
Cinapsis helps eliminate unnecessary referrals by providing a platform for clinicians to securely share clinical images and expertise in a matter of seconds. Colleagues can then work together to decide the best course of treatment for the patient.
In Norfolk and Waveney, the app has helped cut waiting times for specialist advice from 50 weeks to 48 hours, while in Cheshire and Merseyside, it has saved the NHS an estimated £1million per year.
Owain explains how community GPs benefit from the app.
“I would be on call in A&E supporting GP trainees. Many hadn’t done any ENT before. I could advise them over the phone and they became skilled very quickly. But as soon as that GP started working in the community, that support was gone.
“It was really obvious to me that the answer to this was to allow clinicians to communicate with one another, easier and allow them to get advice from the consultant or a specialist.”
It took a lot of work to get a foot in the door at the NHS, which can be slow to adopt new technologies. The team had to overcome numerous hurdles and make sure that the product was compliant with the most stringent standards – from regulation and data protection to risk and resilience.
But the hard work paid off and now, Cinapsis is having a considerable impact.
“For an elective specialty like dermatology, that conversation avoids the patient needing to have a face-to-face or virtual consultation 70 per cent of the time.
“That has a huge saving for secondary care, because dermatology is seeing a year-on-year increase of 20 per cent in their two-week wait referrals. Being able to manage them quicker, easier, more conveniently in the community, is a huge saving for them.”
For unplanned, urgent and emergency care, the impact is even greater.
Customer data shows that Cinapsis helps secure a better outcome for the patient 83 per cent of the time.
In 30 per cent of cases, the patient can be managed in the community. And more than 50 per cent of the time, even though they have to be seen in the hospital, they can be seen another day in the clinic, rather than that day in A&E.
“It seems like such a small change. But Cinapisis allows them to convert emergency care into planned urgent care. Seeing patients in a clinic where there’s a time slot, they have the resources, they know what the problem is, they know what needs to be done for that patient, even before they’ve come into the hospital.
“Comparing that to patients ending up in A&E, the doctor doesn’t know anything about them, there needs to be triage… So the experience for the patient is much better.”
“For the service, it’s much better as well, because the problem that they have in secondary care is managing peaks in demand.
“You’re coming to the end of your shift and then four patients turn up in A&E, they need to be seen then. That disruption has a huge impact on burnout and the ability to plan the work. Such a simple thing has a big impact across the breadth of medicine.”
While Cinapsis is clearly having tangible benefits across the NHS in England, it took a while for some sceptics to appreciate its potential.
People understood why GPs would like the platform, but why would specialists give up their time to talk to GPs when they’re already busy enough?
But by demonstrating in practice that it helped consultants in secondary care to manage their workload better, the sceptics became advocates. Clinicians liked that way of working. There were benefits to all stakeholders.
“Then Covid arrived and it became dangerous to have patients come into the hospital when they didn’t need to. At that point, it really changed from being a good idea to an absolute imperative.
Very quickly, acute clinicians were calling for Cinapsis to be rolled out further, faster, and to more specialties as a way of keeping these patients out of the hospital.
“So it was really an overnight change from saying, this is the right thing to do for the system and for patients, too, we have to do it right now, as quickly as possible.”
The app is now used across large parts of England, including Gloucestershire, Wiltshire, Cambridgeshire, the Black Country and Merseyside, spanning many specialties.
In the southwest, Cinapsis covers more than 100 specialties, from paediatrics and palliative care to dermatology and respiratory trauma.
“One area that we’re really excited about is ophthalmology because it contributes 20 per cent of the waiting list backlog. We’ve done a very successful project in Cambridge and Peterborough recently and now it’s being adopted in different areas as well.
“Ophthalmologists in the community have been neglected a little bit in terms of their access to NHS IT services.
“So it’s been really exciting to bring them into the fold and provide them with the same technology that we’re providing to GPs.”
This is an excerpt from our Special Report – Working Smarter in a Post-Covid World
