We recently hosted a webinar highlighting how our Referral Triage service has supported hospitals with referral backlog challenges and staffing shortages in elective care.
Adam Shakir, Consultant in ENT and Head and Neck Surgeon in Milton Keynes, Louise Tuckett, Director of Strategy Planning and Performance at The Rotherham NHS Foundation Trust, and Sophie Paddick, Account Manager at Consultant Connect, examined the operation of the service within an existing project.
How Referral Triage operated in elective care in Rotherham NHS Foundation Trust
Louise Tuckett spoke of the challenges within the trust, including an increase in the volume of referrals, reduced staffing capacity and the clinical risk of new patients waiting too long, stating that a number of patients on their elective care lists have been waiting for over 26 weeks for a first appointment.
‘The process was straightforward: Consultant Connect brought on board out-of-area NHS consultants from their National Consultant Network (NCN) who assessed and reviewed the backlog of referrals in Cardiology, ENT and Gastroenterology and decided whether the patients required an appointment. If so, whether this was urgent or routine, face-to-face or virtual, and whether they could go straight for diagnostics, bypassing an initial appointment entirely.
‘Referral Triage brought the straight-to-test pathway to light, whereby a patient can undergo further tests without needing an initial appointment. Of over 1000 Gastroenterology referrals, 45% resulted in patients going down the straight-to-test route. If diagnostics were required, the NCN consultant defined the necessary test and any other considerations to be taken into account.
‘As a result of the Referral Triage project, a lot of patients were booked straight into clinics for first appointments; however, these were the correct patients who needed to be seen and whom specialists saw sooner because they were prioritised. Urgent referrals were highlighted by the NCN consultant, which we would’ve struggled to recognise, and the team received quick responses for further action.’
Deflecting referrals back to Primary Care
‘A huge factor of the Referral Triage project was determining whether a patient needed to be seen in Secondary Care or if they could be managed appropriately in Primary Care. If they did not require to be seen in Secondary Care, then the NCN consultant returns the referral back to the GP with clear advice on what they needed to do and how best to manage the patient outside an acute hospital setting.’
Adam Shakir, a Consultant on the NCN who provides Advice & Guidance and triages referrals, explained the benefits of the service:
‘Referrals that are deflected back to Primary Care are done so with sound, clinical professional advice, and clear actions. The information is so in-depth that it is as though the patient is receiving a specialist opinion via their GP.’
Mitigating concerns from local teams
Louise discussed the initial concerns from the specialist teams surrounding the clinical knowledge of the consultant reviewing the referrals via the service. This was soon alleviated when the specialists had an introductory clinical meeting with the triaging consultant, building trust and confidence between the specialists.
‘The external clinical expertise with a fresh set of eyes has proven invaluable throughout this project.’
Adam added to this and explained his process of consistently communicating with the teams throughout the project to ensure high standards were maintained.
Alongside Cardiology, Gastroenterology and ENT, Louise discussed how the trust trialled Referral Triage within Rheumatology but didn’t feel the process was as impactful for this specialty.
‘Consultant Connect were very flexible with the service, and the team were more than happy to trial various specialties on a small basis, increasing the number of referrals being triaged, depending on the success.’
Setting up a Referral Triage project
Sophie Paddick explained the process for Referral Triage projects, which includes determining the number of specialties, involving the stakeholders, and ensuring workflow streams are aligned.
‘Initially, we would bring NHS admin staff on board to provide reports to the trust and extract referrals from the booking system. Then, we ensure that the NCN consultant has knowledge of any local pathways to which patients can be directed. The referrals are uploaded to the IG-secure Consultant Connect system, where they will be triaged and then re-uploaded to the booking system to allow the trust’s teams to take the next steps. There are multiple ways in which we can triage referrals. We can triage an existing backlog of referrals; referrals can be triaged as they come through the front door, or we can review and validate follow-up lists.’
If you have any questions or would like more information about Referral Triage, please call us on 01865 261467 or email hello@consultantconnect.org.uk.
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