Healthcare delivery


experiences of referrals found the group expressing the most dissatisfaction with the referral system were those people suffering with musculoskeletal problems, chronic pain, foot complaints, skin conditions and mobility problems.13 The same study also found respondents


with recurring conditions felt frustrated by the slowness of the referral system and the toll it was taking on the physical and mental health. Patients felt “frustrated and dissatisfied that they have to jump through the different hoops of the referral process”, they were “bounced around the system” and it was their condition rather than themselves that was being treated.13 A recent IPSOS Mori poll13


shows that the public


remain concerned about accessing the care they need; 74% of respondents believed waiting times for elective care are too long, although they understand the scale of the problem facing the NHS.14


Freeing up GP and hospital time Prior to the implementation of the digitalisation of the MSK referral process, GPs would need to pass referrals to the practice administrative team to laboriously complete the paperwork and include all the relevant documentation. What happens now is the GP can fill out the referral with auto-loaded clinical attachments in less than 90 seconds during the consultation. This time saving equates to 3.5 minutes for every


patient referred for treatment which when added up over the course of a year could save up to 3000 GP hours in our area. This is the equivalent of putting another GP into the health service. The technology works as it is not just an ‘add on’ but a clear pathway for clinicians to follow and has made it easier for GPs and hospitals to manage referrals into secondary care. GPs are coming under pressure and there


have been other initiatives that have sought to relieve the burden on them and address workforce challenges, such as increasing the skill mix within surgeries. However, a recent study has shown including non-medical roles such as paramedics or physician associates has done little to lessen GPs’ workloads or increase their job satisfaction.15 There can be little doubt that GPs are under


pressure, as the numbers are declining at a time when there is rising demand,16


and each year they make around 9 million which means it can


be hard for them to juggle competing priorities. 50% of all referrals, not just MSK ones, come from GPs17


referrals to hospitals for elective care.18 We receive 50,000 MSK referrals annually


from the 116 GPs in the areas covered by our Trust and it is clear using the digital referral


58 www.clinicalservicesjournal.com I June 2023


system has vastly improved the patient experience – while, at the same time, also supported GPs. The Topol Review19


8 Musculoskeletal Conditions - Data - OHID (phe. org.uk)


identified


how greater use of technology within the medical sector could improve patient outcomes by providing the opportunity to improve the quality of interactions between not just doctors and patients, but also between doctors and clinicians.19


An automated triage system is an


effective way of solving the waiting list problem and supporting GPs in the process.


Reducing time and cost pressures Enabling data sharing and collaboration between primary and secondary care is key in delivering better patient outcomes and can help reduce the overall time and cost pressures on the NHS. A recent study into the duplication of referrals in Irish Clinical Genetic services over a three-month period found that 8% were duplicates and involved a ‘tsunami of paper.’ If the duplicates were replicated across the wider Irish health service, this could be costing the health service a considerable amount and increasing the waiting time for patients.20 Digitalisation of the referral process could mitigate against this risk. Being incorrectly referred to the wrong


waiting list has an impact on both the patient’s health and experience and, if multiplied by the thousands, reduces the opportunity for NHS Trusts to tackle elective care waiting list backlogs. We are confident that our digitalised system has the potential to make a significant financial impact running into millions of pounds over the coming three years. The cost savings will be due to reduced new patient appointments, improved waiting times and the self-management of care by patients, where relevant.


9 C1466-delivery-plan-for-tackling-the-covid-19- backlog-of-elective-care.pdf (england.nhs.uk)


10 https://www.longtermplan.nhs.uk/ 11 Leal, J., Gray, A. & Javaid, M. (2016). Impact of hip fracture on hospital care costs: a population- based study. Osteoporos Int. 27, 549-58. DOI: 10.1007/s00198- 015-3277-9


12 NHS Winter Watch 2021/22 (nhsproviders.org). 13 understanding-patients--experiences-of- referrals-12_12_19_pdf-83467587.pdf (gmc-uk. org)


14 Three in four say waiting times for NHS emergency treatment are too long while a majority are not confident they will be seen quickly in A&E, Ipsos.


15 Employing other clinicians doesn’t reduce GPs’ workload (nihr.ac.uk).


16 Pressures in general practice data analysis (bma.org.uk)


17 Outpatients- the future report, adding value through sustainability, Royal College of Physicians 2018


18 Hospital Outpatient Activity 2021-22 - NDRS (digital.nhs.uk).


19 The Topol Review — NHS Health Education England (hee.nhs.uk)


20 Duplication of referral, a tsunami of paper: how much does it cost the Irish health services? SpringerLink


CSJ


References 1 A woman living with osteoarthritis: A case report, Cases Journal, Full Text (biomedcentral. com)


2 https://www.versusarthritis.org/about- arthritis/data-and-statistics/the-state-of- musculoskeletal-health/


3 Why are musculoskeletal conditions the biggest contributor to morbidity? - UK Health Security Agency (blog.gov.uk).


4 The State of MSK Health 2021 (versusarthritis. org).


5 Voices of our ageing population - Office for National Statistics (ons.gov.uk)


6 Making sense of the evidence: Multiple long-term conditions (multimorbidity) - NIHR Evidence.


7 https://www.bhrhospitals.nhs.uk/about-us.


About the author


Marie Loizides, a trained physiotherapist, is associate director of performance analytics at Barking, Havering and Redbridge University Hospitals NHS Trust. She worked on the clinical side for 15 years and then as an operational manager in the NHS for five years. Prior to qualifying as a physiotherapist, Marie was a programmer and systems administrator. This background has enabled her to see digital solutions across all the areas she has worked within the NHS. Marie is an accredited coach, a Digital Health.London digital pioneer fellow and Agile PM Practitioner.


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