Top tips for a successful Referral Triage and Validation project

‘To share data in the most helpful way, we always work with the trust to understand what they’re evaluating as part of the service, so we can create and edit bespoke outcome sets to inform any improvements made to the service. Rather than the options for a referral being simply “accept” or “reject”, they will be more informative and detailed, indicating specific clinics patients should be booked into. We’ve also added the element of evaluation data for prospective services, so if clinic X was available, then Y number of patients would’ve been suitable for that provision, saving them from being directed to secondary care. This is invaluable for pathway re-design work.

‘Specialties that you can typically gain a lot of insight from the patient’s history and don’t require them to be present really benefit from triage. Additionally, specialties that have local community provisions available perform well. Our service is very adaptable; we can trial a set number of referrals within one specialty, and if we don’t see the desired results, we can transfer the triage across to another specialty. In one instance, we quickly realised when triaging paediatric and adult ENT referrals that it wasn’t of any value to the trust to continue with the paediatric cases, so instead we switched the workload to focus on the adult patients.’ – Grace Jackson, Referral Triage and Governance Lead at Consultant Connect.​

‘Firstly, we meet with local teams to reassure them that this is a partnership, not a takeover; it’s a professional, polite and positive conversation, understanding how we can integrate into their department. This allows us to understand the local services and pathways available so we can specifically advise on clinics to book into. I have a checklist of questions that helps me gather the information I need to effectively triage referrals and provide useful outcomes for the trust.’ – Dr Sonna Ifeacho, NHS ENT Consultant on the NCN.

‘It’s the reassurance that we’re an extension of the local team from day one. Everything we do as part of every single project is on their terms within their team. It’s important to have that collaborative relationship with a mutual understanding of what to do with patient referrals, especially those needing action ASAP.’ – Grace Jackson.

‘After meeting the local teams, the referrals are uploaded to the Consultant Connect platform, which I really love using. If I could describe it in one word, it would be “water”: it flows, it’s very straightforward and easy to use. The design of the software is very pleasant to the eye, and it allows you to open PDF documents in a single view, so you don’t need to maximise and minimise windows. It’s a lovely system to use for referrals, and all the details are in one place to make an informed decision.’ – Dr Sonna Icheafo.

‘For specialties like cardiology, a number of patients need to be seen in a specialist clinic but would benefit from an interim diagnostic test. This is because, although they need to have a discussion and exploration of their symptoms, some of their issues will be informed by the test results. So, we can have the test booked early in the triage process, meaning when the patient does attend their clinic appointment, the results are ready and, hopefully, they only need to attend once rather than twice.’ – Dr Stephen Cookson, NHS Consultant Cardiologist on the NCN.

‘The straight-to-test process evolved quite quickly because we could see these patients being sent for diagnostics internally, causing another bottleneck due to the test results needing to be reviewed. Therefore, we improved the service to receive the diagnostic results back on the Consultant Connect platform for the triaging consultant to review and then re-triage.’ – Grace Jackson.

‘When conducting my Consultant Connect work, I ring-fence my time, so I have dedicated space to concentrate on referrals, where I’m not going to be interrupted by phone calls or patients. It’s lovely to sit down and read through the referrals, get the nuance, and then decide on the outcome or write out a comprehensive management plan. Having that dedicated time not only ensures the right outcomes and priority for each referral, but where management advice is given, I go into plenty of detail. It’s not a few broad sentences; it’s several paragraphs explaining what and why. It’s also unofficial education because GPs understand the rationale. So, subsequently, if they have a future patient with similar symptoms, they are empowered to treat them without making a referral in the first instance. Approximately one-third of ENT referrals are suitable to be managed in primary care with detailed guidance. Based on that, there’s the opportunity for the trust to set up their own specialist Intranet sites where they can provide links to, and documents for, guidance tailored to their primary population. I can then refer to this in my management plans as an explanation so that the GP has a justification for their decision. Overall, it’s a great service to be a part of. I think this is the practice of medicine in the modern era.’ – Dr Sonna Ifeacho.  

‘I can triage referrals a lot faster using the Consultant Connect platform than I can with e-RS, making it more time efficient and enjoyable. In my experience, on average, around 25-30% of cardiology patients on waiting lists can be appropriately managed within primary care with detailed advice. These patients don’t necessarily need a diagnostic test but would benefit from a management plan and reassurance. Additionally, another portion of patients would benefit from a simple diagnostic test often available within primary care, such as an ambulatory ECG, echocardiogram or 24-hour blood pressure monitor, so we can request those tests and then rapidly review the results when they are returned. Around three-quarters of those patients can be returned to their GP with the test result and a management plan, with the other quarter needing to come into clinic. Not only are we reducing the number of people coming to the hospital, but we’re also getting patients on track to their diagnosis with specialist input. It’s about adding value to the system by improving efficiency.’ – Dr Stephen Cookson.

‘We know that GPs are under as much pressure as secondary care in terms of workload, demands, and waiting times, so giving the local GPs the ability to get back in touch with the triaging consultant after receiving a returned referral is really important. Where the trust is happy to do so, we provide a dedicated direct phone number with the local trust prefix, which routes to the triaging consultant’s mobile. That way, if a GP does want to discuss a patient’s case, they have the means to do so. All calls are recorded, and we can quantify the volume of calls received, their duration, and the outcome. The query may be as simple as since the referral was made, the patient’s medical circumstances have changed, and it is now appropriate that the GP re-raises the referral to secondary care. It’s surprising how little this element is utilised: we’ve triaged nearly 5,500 cardiology referrals for one project and had calls regarding fewer than 1% of them. We aim to deliver a thought-out and thorough service, and we hope that having direct lines for GPs alleviates any fears or pressures.’ – Grace Jackson.

‘We create and send detailed reports that never contain patient identifiable data (PID). If an action needs to be taken that requires accessing PID, we have an NHS admin team dedicated to transferring that data safely via NHS email as needed.’ – Grace Jackson.

‘The Trusts actually get two services in one: they receive the clinical triage of referrals and a lot of additional detail about their specialty service. For example, there’s currently a lot of uptake in community ENT, so we can quickly see which patients would do better in the community and how much secondary care capacity would be freed up as a result. This is beneficial data for the ICB/Trust to use for contract design.’ – Dr Sonna Ifeacho.

‘We’ve unlocked so many outpatient appointments that can be used for patients who really need them rather than those who are travelling to clinic to be told they don’t require specialist input. There’s no excuse to use resources this way in the current climate. The whole system has to focus on adding value and efficiency, and we cannot continue to bring everybody to clinic all the time; it just doesn’t work. I don’t have any financial incentive to do anything other than what’s best for the patient, just like my NHS role. So whether I decline a referral, request a diagnostic or book them into clinic, I’m only motivated to do what’s right for the patient.’ – Dr Stephen Cookson.

‘The clinical risk involved with these patients who have been waiting so long in whichever specialty is huge. It’s of massive benefit that we do what’s right for the patient, and making sure that the quality of care provided is majorly important, and that’s our central focus.’ – Grace Jackson.

‘Consultant Connect just shows what is possible. The service works, especially for surgical specialties. You might think all patients need to be physically examined, but this has proven that many patients have yet to be optimised medically, and that’s a very valid outcome.’ – Dr Sonna Ifeacho.