NHS hospitals with clinical capacity challenges turn to our National Consultant Network (NCN) of NHS consultants. Like all other specialties available on the NCN, the neurologists work remotely, following local pathways and protocols, under the leadership of local clinical leads. As ‘virtual locums’, they can:
Review neurology Advice & Guidance (A&G) queries on e-RS or other systems with no change to current flows: A recent project resulted in 83% of neurology A&G cases being returned to primary care with a detailed remote management plan and advice
Triage and validate referrals: safely reducing neurology waiting lists by 30-50% with:
- Diagnostics initiated where needed
- Important upgrades and downgrades identified
- Cases returned to Primary Care with management plans and advice
- Follow up lists validated if needed
When delivered by consultants, validation and triage ensures patients are on the correct pathway, urgencies are identified, and management plans are written up where appropriate, for primary care to implement and keep the patient in the community. The level of support and guidance from the consultants means that the management plans are not dissimilar to a first outpatient appointment.
Dr Jonathan Evans, NHS Neurology Consultant triaging referrals through the service comments:
‘Neurology is very well-suited for remote triage because neurological disease is rare and symptoms are common and there are very clear pre-hospital pathways. Consultants are quite often directing Primary Care clinicians to these pathways and using existing guidance. The more these pathways are utilised, the more refined the referrals become, following best practice guidelines and exhausting all available avenues before a referral is sent.’
Example 1
This NHS Trust used the service to clear a backlog of over 1,000 neurology referrals:
Key impact:
49% of referrals were safely removed from the waiting list, including:
- 41% returned to primary care with a detailed management plan and advice
- 4% returned to primary care for clarification and further information
- 4% redirected to another service
50% of referrals were directed to the right place, first time:
- 26% accepted as routine to be seen general clinics
- 14% accepted as routine to be seen in specialist clinics
- 4% upgraded to urgent to be seen in general clinics
- 2% accepted to the First Fit service
- 2% accepted for routine appointment (without diagnostics)
- 1% accepted for routine appointment (with diagnostics)
- 1% upgraded to urgent to be seen in specialist clinics
*Due to rounding, the sum may not equal 100%.
Example 2
What started in 2022 as a pilot to clear a backlog of neurology referrals, quickly expanded as this Trust was also seeing a high volume of both new-in neurology referrals and new-in e-RS A&G requests coming in from local GPs.
Given the Trust had local neurology consultant capacity challenges, a project was initiated with NCN neurology consultants brought in to support with three workstreams:
- Triage and validate their backlog
- Triage and validate new-in referrals
- Respond to new incoming A&G requests on e-RS
More recently, this project was expanded to support with validating the Trust’s neurology follow up lists. Over 500 cases have been reviewed by the NCN to date, and early data is impressive:
- 29% were able to be discharged to a PIFU Pathway
- 17% were able to be discharged in full
- The remaining 54% were prioritised appropriately based on the urgency of the required follow-up appointment.
Key impact:
Workstream 1 | Clearing the backlog of over 1,100 neurology referrals:
37% of referrals were safely removed from the waiting list, including:
- 27% returned to primary care with a detailed management plan and advice
- 10% redirected to another service within the trust
63% of referrals were directed to the right place, first time, including:
- 39% accepted for routine appointment (without diagnostics)
- 4% accepted for routine appointment (without diagnostics but with interim GP advice and treatment plan)
- 5% accepted for routine appointment (with diagnostics)
- 1% accepted for routine appointment (with diagnostics and with interim GP advice and treatment plan)
- 4% accepted to the first fit routine service
- 4% accepted and upgraded to the first fit 2WW service
- 3%redirected for Nurse Follow-up
- 1% redirected to MDT
- 2% accepted without diagnostics and upgraded to urgent 2WW
- 1% accepted with diagnostics and upgraded to urgent 2WW
Workstream 2 | Triaging over 1,200 new-in referrals:
- 35% of referrals were removed from the waiting list and discharged back to the referring clinician with a detailed remote management plan and advice
- The remaining 65% of referrals were prioritised and navigated appropriately, with diagnostic and testing requests initiated where appropriate.
Workstream 3 | Reviewing over 900 e-RS A&G queries from GPs:
The Trust also used the expertise of the NCN consultants to review new-in e-RS A&G requests. To date, over 900 A&G requests have been reviewed in an average turnaround time of one working day.
The prompt turnaround time has meant patients have been triaged quickly prior to an unnecessary referral being initiated, with many remaining in the care of their GP with detailed management plans:
- 83% of cases are returned to primary care with a detailed management plan and advice
- 16% of cases converted to referral
- 1% of cases requiring further information
For more information:
If you have any questions or would like to discuss how our Referral Triage and Validation service or the National Consultant Network can support your area email hello@consultantconnect.org.uk or call us on 01865 261 467.
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