Marie Loizides, of Barking, Redbridge and Havering NHS Trust, explains how switching to digital referrals in North East London has made a positive impact on both patients and clinicians.
As a physiotherapist I have seen first-hand how devastating it is for a patient to come in having waited many months in pain for treatment, only to be sent to the wrong place when they actually needed to see a different service or clinician.
If information is missing from a referral, it takes longer to process and it is more likely the patient will be sent to the wrong clinic.
In North East London, 3000 referrals a year were previously being rejected because they did not include key clinical information such as x-rays, reports or images for complaints including knee, neck, back and shoulder pain.
This meant patients were frustratingly being put back in the queue as they continued to wait in pain for treatment. Additionally, clinicians were using valuable appointment time just to refer patients elsewhere. This needed to change.
Transforming the GP referral process
A project led by Barking, Redbridge and Havering NHS Trust was launched to end traditional paper referral methods and switch to a digital process.
The aim was to enable electronic patient data to be shared securely and simply between clinicians to improve the referral experience and ensure patients attended a good quality consultation, at the correct clinic, first time. This would help to ensure valuable appointments weren’t being wasted too.
The North East London Musculoskeletal (MSK) Alliance (an alliance of NHS Trusts and the Integrated Care Board) was formed to bring greater collaboration across the area and streamline the referral process with the help of digital data sharing through a single triage team at the hospital.
We are now able to bring consultant-led triage into our local GP surgeries with the help of NEC Rego, a digital patient referral tool that brings key information together in one place and enables referrals to be tracked in real time.
It means that when a patient arrives at the GP with a complaint such as back pain, all their medical data can be viewed and assessed alongside prior input from the hospital team.
With a more complete picture, the GP can then make an informed decision on what treatment option is most appropriate, whether that’s self-management, physiotherapy or surgery.
This prevents patients being given appointments at the wrong clinic as the hospital triage team has already assessed which service is most appropriate before the appointment is scheduled.
The digital referral process is supported by a sophisticated AI algorithm which helps to ensure the right treatment pathway is in place for each condition we treat.
The different treatment pathways are set by practitioners and experts in patient care, including GPs, primary care providers, hospital clinicians consultants and physiotherapists.
The initiative has prevented the previous challenges of referring patients with incomplete information as referrals can only be processed with all the required key data included.
This provides a more complete picture of the patient’s condition so they can effectively triage to the correct MSK service.
Better patient outcomes
Since using the new system, accurate referrals have increased by 70% and we have reduced waiting times by over a month.
Ultimately, improving the referral process means better outcomes for patients by ensuring they receive the best care as quickly as possible.
Previously the frustration of transferring between services could take many months during which time the patients’ condition might deteriorate.
Seeing the correct service first time and providing earlier management of conditions may prevent long term disability or reduce the need for surgery.
Furthermore, it’s more likely that a patient can successfully self-manage their condition the earlier they are seen which not only improves wellbeing, but also reduces pressure on NHS resources.
Saving hospitals and GPs time
The digital process is much more efficient and we have seen great time savings from the patient’s initial contact with the GP through to the hospital services.
Prior to the implementation of the digital referral, GPs would need to pass referrals to the practice administrative team to laboriously complete the paperwork and include all the relevant documentation.
Now, with more data shared electronically, the GP can fill out the referral in minutes whilst in the consultation with the patient.
This time saving equates to 3.5 minutes for every patient referred for treatment which could save up to 3000 hours over the year, the equivalent of putting one GP into the health service.
The hospital triage team has also been able to process referrals more quickly, they have been able to halve the processing times for referrals received.
There is also the considerable time saving achieved by avoiding unnecessary appointments and getting patients to the correct service first time.
Collaboration is key
With 50,000 referrals annually from 116 GPs, it is clear using the digital referral system has vastly improved the patient experience.
Enabling data sharing and collaboration between primary and secondary care is key in delivering better patient outcomes.
Furthermore, all stakeholders involved in a patient’s care benefit from the time and cost savings it offers and overall pressure is reduced on the NHS.
- Marie is the associate director of performance analytics at Barking, Redbridge and Havering NHS Trust
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