A then Primary Care Trust (PCT) had identified the need for a new range of services.
Between the NHS’s Primary and Secondary services (GPs and hospitals), they had identified issues where contracted services were being massively underutilised causing patients to travel to Hospital settings when in fact the service was provided in Community settings often closer to home. However, the existing system to refer patients was not fit-for-purpose and did not support the GP to refer into Community services but encouraged referral to Secondary (Hospital) providers.
Overlooked and underutilised by hospitals, GPs and patients alike, the nationwide ‘Choose and Book’ (CAB) system was used less than 30% of the time. Even when it was, there were issues with patients being sent to the wrong place and often GP doctors being unaware of what services were available and where. This lead to huge amounts of wasted time for patients and care providers alike, increasing costs to the NHS when referrals were not submitted accurately or to the correct care provider. Patients would often attend appointments to be told they needed to attend another service, the pathway for the patient was far from a positive experience.
The Accenda team understood the scale of the problem right away with their knowledge of the NHS and Primary Care processes at the forefront when developing the solution. As GPs were largely unaware that they could offer patients access to community services – with shorter waiting times, more cost effective tariffs and more convenient access for patients – this meant unnecessary costs and time delays were accruing for the NHS and its patients. We knew our task was to find a better process for coordinating referrals and implement it in such a way that it would get patients to the right place at the right time.
We went about things in a collaborative way, embedding and immersing ourselves in the world of GPs, Primary, Secondary and Community Care and how the referral process worked. Or more to the point, didn’t. We spoke to commissioners, patients, GPs, consultants; looking to understand the unique problems of each audience, but how they related to each other. We also analysed a key influential report from the King’s Fund which highlighted issues with the existing referral management approach. It spoke of doctors resorting to faxes rather than use ‘CAB’, referrals being lost in antiquated filing cabinets, and other anecdotal references to issues occurring due to human error under the old approach.
Filtering the vast amounts of information, we had amassed – from reports, interviews and our teams combined industry experience – we realised it simply wasn’t enough to have referral management, healthcare organisations needed referral support. Moreover, the only effective way to do this was with a sophisticated, digital solution that made things simple for users. It had to be integrated, it had to be secure, and most of all it had to be capable of managing the 600+ referrals made every day in the PCT area.
The result of our thinking, research and hard work was the creation of the Integrated Care Gateway (ICG). This powerful digital solution put control back into the hands of the people who needed it, streamlining processes, cutting unnecessary admin time and giving healthcare professionals proper insight into what was happening within their own referral process.
The first step in the ICG is a special clinical template that was created in consultation with both Primary and Secondary Care providers to create standardised high quality referrals. Designed in such a way that GPs and Secretaries could use it quickly, efficiently and intuitively, it features simple drop-down lists, an easy-to-understand interface and a straightforward data capture tool. However, the critical part was how we integrated it with a wider system, capturing data electronically to give heathcare professionals access in real-time, meaning they can check on where a referral is up to at any time during the four-step process.
Our solution is built on a gated process including Clinical Triage. This is an innovative system for ensuring clinical experts get the chance to review and offer specialist knowledge in a particular area (e.g. GPwSI). After the referral has been validated and received, our triage specialists have a 48-hour window to screen the referral and bounce it back to the original GP, along with their expert advice. If there is no intervention within two days, the referral is automatically progressed to booking to avoid delays in the Patient pathway. Having this electronic system in place allows for a better, quicker, more accurate and efficient process.
Another key benefit of the Integrated Care Gateway is the way it enables sophisticated data reporting. Previously, healthcare professionals were unaware of referral trends and outcomes often receiving sparse data some six weeks after the referral was booked. Our solution allows for a more insightful analysis, offering a rich picture of what is occurring and working well or not within an organisation. Users can see data spikes, referral trends and foresee potential issues, all in real-time.
The results were immediate and definitive. Overnight, usage of the Community Services jumped from 30% to 80%. Our solution is now the leading solution for referral support, and is saving CCGs in England several £millions per year. We’re already working on an update that will be even more efficient and save more costs, reducing the workload in Primary Care and streamlining the process even further.