Healthcare delivery


super-clinics, using state-of-the art diagnostic equipment and harnessing technology to streamline work processes7


the key principles in the NHS plan to tackle the backlog.9


Preventing rejected referrals Improving patient access to care and tackling the backlog remains an ongoing priority and for our corner of the NHS in North East London. The kickstart to change was the length of time patients were waiting for physiotherapy. The wait time ranged between six to over 26 weeks depending on where the patient lived. This was too long, and we wanted to reduce the time between referral to treatment. So, we decided to conduct an audit of our referral process to see what improvements could be made. What we discovered was that 3000 referrals a year had been previously rejected because they were missing key clinical information. This included diagnostic imagery like x-rays, images for complaints including knee, neck, back and shoulder pain and reports. If a referral is missing vital information, then it can’t be processed quickly and it makes it more likely that the patient will be sent to the wrong clinic. We wanted to address these delays in the system. Postponing medical care by prolonging the


wait time for MSK patients makes it less likely they will be able to self-manage their condition4 and we could see the impact delayed treatment was having among our own physiotherapy patients. We knew if we could prevent rejected referrals, it would positively impact on waiting times and ensure that specialists’ diaries were filled with patients who they could treat and not have to refer on.


Bringing clinical decision making into the GP surgery The need to digitalise aspects of outpatient services was a key focus of the NHS Long Term Plan10


and we decided we could improve the


quality of referrals by making the shift from a paper-based referral system to a digital one. The


feature as some of


aim being that valuable appointments weren’t wasted due to incorrect referrals and patient waiting times were kept as short as possible. Going digital would enable electronic patient


data to be shared securely and easily between primary and secondary care, which would improve the referral experience and ensure patients attended a consultation at the correct clinic the first time. Bringing clinical decision making into the


GP surgery was also a key ambition and, with the help of NEC Rego, we developed a clinical algorithm to make our vision a reality. We consulted with a wide range of


stakeholders who are practitioners and experts in patient care, including GPs, primary care providers, hospital clinician consultants and physiotherapists to set different treatment pathways. We then developed and refined the AI algorithm to ensure the agreed right treatment pathway is in place for each condition we treat. What happens now is that when the GP is with the patient, they can fill in the referral form in real time. The algorithm prompts them with a series of questions to consider ensuring the patient is referred to the correct service to meet their needs for example a consultant or physiotherapist. Should more diagnostic tests be needed before a consultation with a specialist the referral tool will prompt the GP to complete these preventing delays in accessing the correct care. Getting the answers right the first time vastly reduces waiting times as the patient sees the right clinician from the outset.


Correct clinical pathways As a result of the changes we have introduced, we have seen a reduction of over 50% in consultant-to-consultant referrals within the Trust, as the correct RTT pathways are being used. Most GPs are now frequently filling in the referral forms during patient consultations, as they are so quick and easy to do, rather than handing them to their admin teams. Since we digitalised the MSK referral process, we have reduced patient waiting times by over a month,


as triaging cases takes half the time it used to take. Now, when a patient speaks to their GP about joint or knee pain, the doctor can view all their medical data alongside any prior input from the hospital team. As the GP has a more complete picture, they can make an informed decision on which treatment option is most appropriate for their patient by answering the questions posed by the digital tool. 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. Accurate referrals have increased by 70% as a result and there is a greater consistency of care for the patient. This has been very beneficial for our patients as being correctly referred to the right service when first seeking help from the GP increases their chance to self-manage their condition. This improves wellbeing and reduces pressure on NHS resources. Earlier management and treatment of the conditions can also reduce the potential of long-term disability and surgery. Each year, the hospital cost of hip fractures for the NHS is estimated to be £1.1 billion.11


Losing patients and patience Referrals to our services run into the thousands. Trauma and orthopaedics are one of the six specialties that make up 50% of our Trust waiting lists, alongside general surgery, ear nose and throat, ophthalmology, urology, and gynaecology.12 MSK patients rely heavily on primary care


too. Each year one in five adults consult their GP about an MSK condition;4


22% of those surveyed


by Versus Arthritis described their general health as bad or very bad compared to 7% of the general UK population.4


with MSK conditions surveyed cited having all “their conditions and symptoms treated together, rather than separately would be the number one thing that would have the most positive impact on their life.”4 A study commissioned by the GMC to gain a deeper understanding of patients’


June 2023 I www.clinicalservicesjournal.com 57 In addition, 42% of people


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