Improving the care of gynaecology patients and those with menopause symptoms

Our Referral Triage and Validation service uses the expertise of NHS consultants on the National Consultant Network (NCN) to remotely triage waiting list backlogs in bulk and/or new referrals as they come in. With a variety of specialties available, our service helps to ensure patients are seen in the most appropriate way.

In July 2022, a Referral Triage project at the University Hospitals of Coventry and Warwickshire was set up due to a backlog of gynaecology referrals. Under the leadership of local clinical leads and following local pathways and protocols, the out-of-area NHS consultants triaged over 2,800 referrals. The outcomes* showed that of those referrals, only 49% of patients needed to remain on the waiting list to be seen by a specialist. The remaining 51% were deemed suitable for treatment on alternative pathways and so were returned to Primary Care with detailed and thorough Advice & Guidance for patient management.

Of the 49% on the waiting list, 35% required a routine referral, with a further 2% upgraded to an urgent pathway and 7% upgraded to a two-week wait (2WW) pathway. This meant that those patients not requiring a specialist opinion were returned to their referring provider with a comprehensive management plan, but in addition, upgrades were quickly identified and prioritised. This ensured that all patients were on the correct pathways, allowing for the fastest and best treatment.

‘I find that about a quarter of the patients who have been referred to hospital don’t need to go there – and that saves a lot of capacity. There are a small number of people sitting on the waiting list who need to be treated urgently. Getting the opportunity to review them means they get seen quicker.’

– Mr Eric Mutema, NHS Consultant Obstetrician and Gynaecologist triaging and validating referrals via the service.

* Due to rounding, the sum may not equal 100%

In addition to triaging backlogs of referrals, our Referral Triage and Validation service can also be used to remotely review and validate referrals and follow-up lists to ensure patients are seen or discharged in the most suitable care setting.

As part of the ongoing project at the University Hospitals of Coventry and Warwickshire, more than 1,300 gynaecology referrals were validated by NHS consultants on the NCN. Outcomes* showed that 22% of referrals were categorised as suitable for a Primary Care Gynaecology Pathway run by GPs with an Extended Role (GPwER). Furthermore, 5% were returned to their Primary Care provider with extensive Advice & Guidance for ongoing management.

Of the 66% of referrals that required an outpatient appointment with a specialist, 10% were upgraded to an urgent or 2WW appointment, meaning 56% could await a routine appointment with a specialist.

As a result of the project, a high volume of referrals was quickly managed, with the added reassurance that all patients were on the most appropriate pathway for them whilst aligning with local services in the area.

* Due to rounding, the sum may not equal 100%

In the last 12 months across Coventry and Warwickshire ICB, over 400 calls have been made to local gynaecology specialists for rapid Advice & Guidance, with calls answered within 17 seconds on average.

Calls last less than approximately three minutes, allowing clinicians to form management plans for their patients quickly, often during the appointment with the patient present. This allows patients to become more involved in their care whilst improving relationships between Primary and Secondary Care clinicians.

With 64% of calls* resulting in patients avoiding an unnecessary referral or admission, specialist outpatient appointment slots are freed up for those who need them. As more patients are treated in the community where appropriate, Enhanced Advice & Guidance is helping more individuals commence treatment without waiting for an initial specialist appointment.

* where an outcome was left

Introduced in June 2023, the Menopause Advice & Guidance line was launched following a discussion where it was discovered that a vast majority of unnecessary gynaecology referrals relate to menopause. This meant that Trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without interim management plans.

Following this, the Menopause Advice & Guidance line was launched across multiple Consultant Connect projects, providing clinicians with access to rapid advice from out-of-area NHS consultant gynaecologists on the NCN.

Over the last year, the service has seen an 83% first-time answer rate, with calls, on average, answered within 40 seconds. 62% of calls* made have resulted in patients avoiding unnecessary admissions or referrals. This meant that those experiencing menopause-related symptoms who didn’t require specialist input were put onto a rapid management plan within the community, reducing the number of unnecessary referrals to Secondary Care.

* where an outcome was left