CLINICAL IT
“It’s instantaneous live data that can be streamed, and at any point in time a practice can review its referrals from even the previous hour.”
A further development of the new system, called the ‘cube’, will allow practices to see how they compare, in the live data, with their peers – if one doctor is doing more outpatient referrals per 1,000, for example, they’ll be able to fi nd out why.
The new system, which went live in April, has a similar basic template to the previous one and works across all the main clinical IT systems used in Manchester.
He said: “We’ve now got an in-house booking team, the Manchester Integrated Care Gateway team, who do the bookings for us.”
That team of around 20 people are based at Burnage, handling around 180,000 referrals a year, and will in the future be employed by the Manchester CCGs.
Teething troubles
It has not all been smooth sailing: moving from the Harmoni system to an in-house NHS one created some security ructions.
Wootton explained: “Under the Harmoni system, our triagers could access it from home, via a password protected VPN. When it came back into the NHS system, everything’s got to be encrypted, so we lost a bit of triage for four weeks, and we’ve seen outpatients numbers go back up again – quite dramatically.
“As soon as you take that gatekeeper out of the way, that number shoots up. We expect it to come back down in the coming months, but it did show the value of the gateway in controlling demand.”
see it as a bit of a pain, but they’ve got live data coming through now, and the trick with this going forward is that if all of your data is going in, you can do data validation against it from the acutes’ SUS data.
“We can monitor 18-week targets with it. Once you start all the pathways on it, and the GP practices gets, when they use the database, an email once the booking is made to drop back into the patient notes. If the patient rings up the next day, they will know who they’re going to see.”
The software is soon being further upgraded to do more advanced screening of the data inputted to screen out errors: males with a gynaecology referral, for example.
Wootton said: “Everything’s auditable, because it’s all electronic – so you know exactly what’s happened to the referral point-by-point. Eventually we want to link it in with outcomes as well. It’s been an exciting project.”
It could even raise some revenue for the Manchester commissioning team, which invested time, intellectual energy and money in developing it, as now others in the region are interested in it, including the Central Lancashire CCGs and also Bolton, which already has a paper-based referral gateway.
48 | national health executive Jul/Aug 12
He added: “There comes a point with gateways where you can only squeeze demand so far – otherwise it pops up in urgent care! But certainly in Manchester, it’s had the effect we needed it to have.
“There’s also ongoing education: advice and guidance goes back on a regular basis to those practices that need it. They can use it for CPD, for QoF and QP points, so for the practice, it’s a good local tool they can use. They may initially
QIPP and savings
Wootton said: “You can see where the effi ciencies lie because if you take it away, referrals go back up.
“Where QIPP comes in is, for example, in the fi rst year, we clearly saw from the triage of cardiology referrals that if we had a Tier 2 Cardiology service in place, we could reduce cardiology referrals big-time: 40% or so.
“A lot of what was being referred didn’t need to be, it could be done as a Tier 2 service, which was established, at a lower tariff and run by three senior GPs. So there’s been a tremendous drop-off in cardio referrals, and QIPP comes from setting up alternative services that are cheaper than secondary care, but it’s also about better utilisation of community resources.
“Our local hospital has a caseload now that is far more complex than it was two years ago. Gateways take out the simplest stuff that used to sit in that pathway. They don’t want to see the ‘basics’, which a community or Tier 2 service could do. There’s defi nitely a case-mix change that occurs.
“We should see, over time, GP variation decreasing, the standard of GP referrals going up, hospitals getting the right information and standards of letters, consultants getting the right mix of patients they should be getting.
“We will get some more savings out of it, and it will pay for itself.”
Asked where he felt Manchester stood in relation to other parts of the country on managing demand, Wootton said: “I believe we’re a pioneer: if you look at all the evidence, the King’s Fund says peer review is the way forward, but it didn’t work for us.
“This, however, pushes the boundaries. Three acute trusts who didn’t believe we’d manage demand, ever, are now having to listen.
“Historically, PCTs have rarely done a good job of managing demand.”
Simon Wootton
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
© The Laird of Oldham
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76