​Greater Preston CCG Referral Management Pilot

Greater Preston CCG Referral Management Pilot

​With the NHS experiencing significant pressure and unprecedented levels of demand, there is a clear requirement for CCGs to explore initiatives where the demand flowing into secondary care can be better managed by ensuring that only the most appropriate cases are referred from primary care for face-to-face consultation whilst also identifying interventions and pathways that would offer patient support locally and more appropriately. To this end, Greater Preston CCG initiated a clinical referral triage pilot in November 2016.

From an initial audit of approximately 400 referrals, we discovered that a large number of referrals were being forwarded to the wrong speciality or were marked NOS (Not Otherwise Specified) along with a significant amount that could have been dealt with via GP advice and guidance or by using alternative Tier 2/ Community services. We also identified a number of referrals that did not meet the policy criteria for POLCV (Procedures of Limited Clinical Value).

Following the presentation of our initial findings and approval by the CCG Joint Executive, a pre-pilot was launched in November 2016 to develop more detailed audit data, with a full pilot running from April to October 2017.

During the pilot, Orr Medical reviewed some 24,000 referrals against a set of specialties defined by the CCG, developing and implementing the following actions base upon the detail and quality of each referral:

  • ​Accept and forward to booking to either secondary care or a community Tier 2 service
  • ​Return to referring GP on the basis of non-commissioned procedure, POLCV (Procedures of Limited Clinical Value) or POLCP (Procedures of Limited Clinical Priority)
  • ​Return to referring GP with advice to manage in primary care
  • ​Return to referring GP requesting further information prior to onward referral and booking
  • ​Reassign to a more appropriate specialty or clinic
  • ​Upgrade to urgent where required and forward by appropriate pathway for 2WW referrals

In addition, a comprehensive data reporting and analysis tool was implemented and developed which allowed us to clearly identify specific areas for CCGs to prioritise where further improvements could be made or where alternative approaches could deliver measurable benefits in terms of patient care, alongside cost and efficiency improvements.

Conclusion

Empirically, the pilot scheme clearly demonstrated the following benefits of clinical referral management:

  • ​Referral quality can be directly improved through targeted GP guidance, advice and support
  • Direct to test pathways can reduce demands on secondary care
  • Tier 2 community services can be engaged to manage patients more effectively at a reduced cost
  • More effective condition specific end-to-end care pathways can be developed
  • More can be achieved for identified conditions in primary care prior to referral
  • Prior approval procedures could be streamlined and carried out as part of the clinical triage process
Empirically, the pilot scheme clearly demonstrated the following benefits of clinical referral management:
Referral quality can be directly improved through targeted GP guidance, advice and support
Direct to test pathways can reduce demands on secondary care

Supporting the delivery of best practice in GP surgeries with the attendant reduction in unnecessary demand on secondary care resources and direct CCG costs, Orr Medical is proud to have contributed to this positive impact on the quality of referrals to secondary care and was subsequently awarded the contracts to provide referral management services to both Greater Preston and Chorley & South Ribble CCGs from November 2017.

With the NHS experiencing significant pressure and unprecedented levels of demand, there is a clear requirement for CCGs to explore initiatives where the demand flowing into secondary care can be better managed by ensuring that only the most appropriate cases are referred from primary care for face-to-face consultation whilst also identifying interventions and pathways that would offer patient support locally and more appropriately. To this end, Greater Preston CCG initiated a clinical referral triage pilot in November 2016.
From an initial audit of approximately 400 referrals, we discovered that a large number of referrals were being forwarded to the wrong speciality or were marked NOS (Not Otherwise Specified) along with a significant amount that could have been dealt with via GP advice and guidance or by using alternative Tier 2/ Community services. We also identified a number of referrals that did not meet the policy criteria for POLCV (Procedures of Limited Clinical Value).
Following the presentation of our initial findings and approval by the CCG Joint Executive, a pre-pilot was launched in November 2016 to develop more detailed audit data, with a full pilot running from April to October 2017.
During the pilot, Orr Medical reviewed some 24,000 referrals against a set of specialties defined by the CCG, developing and implementing the following actions base upon the detail and quality of each referral:
Accept and forward to booking to either secondary care or a community Tier 2 service
Return to referring GP on the basis of non-commissioned procedure, POLCV (Procedures of Limited Clinical Value) or POLCP (Procedures of Limited Clinical Priority)
Return to referring GP with advice to manage in primary care
Return to referring GP requesting further information prior to onward referral and booking
Reassign to a more appropriate specialty or clinic
Upgrade to urgent where required and forward by appropriate pathway for 2WW referrals

In addition, a comprehensive data reporting and analysis tool was implemented and developed which allowed us to clearly identify specific areas for CCGs to prioritise where further improvements could be made or where alternative approaches could deliver measurable benefits in terms of patient care, alongside cost and efficiency improvements.

Orr Medical's Referral Management Service delivers real advantages:

​For Commissioners

Reducing the cost burden of poor or unneccessary referrals while identifying and implementing more efficient and effective primary and Tier 2 care pathways thus directly impacting QIPP delivery.

Reducing the cost burden of
poor or unneccessary referrals
while identifying and
implementing more efficient and
effective primary and Tier 2 care
pathway thus directly impacting
QIPP delivery.

​For ​NHS Providers

​​Directly reducing unneccessary demand on secondary care resources where alternative pathways and primary support ​options can be identified for ongoing patient care regimes.

Directly reducing unneccessary
demand on secondary care
resources where alternative
pathways and primary support
options can be identified for
ongoing patient care regimes.

Reducing the cost burden of
poor or unneccessary referrals
while identifying and
implementing more efficient and
effective primary and Tier 2 care
pathway thus directly impacting
QIPP delivery.

​For ​​GPs

​​​Improving the quality of referrals through advice and shared learning with the attendant reduction in lost surgery hours due to unneccessary follow up and repeat appointments.

Improving the quality of referrals
through advice and shared
learning with the attendant
reduction in lost surgery hours
due to unneccessary follow up
and repeat appointments.

Directly reducing unneccessary
demand on secondary care
resources where alternative
pathways and primary support
options can be identified for
ongoing patient care regimes.

Reducing the cost burden of
poor or unneccessary referrals
while identifying and
implementing more efficient and
effective primary and Tier 2 care
pathway thus directly impacting
QIPP delivery.

​For ​​​Patients

​A more streamlined experience with the potential to improve waiting times for diagnosis and treatment through local primary care and Tier 2 services rather than through elective secondary care.

A more streamlined experience
with the potential to improve
waiting times for diagnosis and
treatment through local primary
care and Tier 2 services rather
than through elective secondary
care.
Improving the quality of referrals
through advice and shared
learning with the attendant
reduction in lost surgery hours
due to unneccessary follow up
and repeat appointments.

Directly reducing unneccessary
demand on secondary care
resources where alternative
pathways and primary support
options can be identified for
ongoing patient care regimes.

Reducing the cost burden of
poor or unneccessary referrals
while identifying and
implementing more efficient and
effective primary and Tier 2 care
pathway thus directly impacting
QIPP delivery.

“Start your conversation with Orr Medical today to explore how we can work with you to drive the efficiency and effectiveness of your primary care referral pathways”

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​Or ​call 0701 239 9097

0701 239 9097

Orr Medical delivering real improvements to CCGs and health partners

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ORR Medical
PO Box 470, Whittle-le-Woods, Chorley Lancashire PR6 6BF