Referral Management Service (RMS) improves care for patients – and reduces cost

Impact

NHS Midlands and Lancashire Commissioning Support Unit’s Referral Management Service (RMS) has improved care and experience for patients as well as reduced costs. Patients have reported that their needs are quickly addressed and they feel better informed. Health care providers are receiving fuller, more accurate and more appropriate referrals and commissioners have better information and resources to be able to plan and prioritise services.

This has been achieved by:

• Automating the booking process and removing responsibility for it from GP practices so they can focus on patient care
• Speeding up the referral process
• Reducing the number of avoidable referrals (by management within primary care)
• Supporting the diversion of referrals from secondary care to alternatives, such as community care
• Improving equity and consistency in referrals
• Giving patients written confirmation of any bookings and better information
• Providing real-time clinical and activity information to clinicians and commissioners
• Helping to reduce clinical variation and achieve best practice
• Helping to direct funds to areas of clinical priority and contributing significantly to clinical commissioning group (CCG) Quality, Innovation, Productivity and Prevention (QIPP)  targets.

Situation

Seven CCGs (St Helens, Halton, Knowsley, Southport & Formby, Greater Preston, Chorley & South Ribble, and Eastern Cheshire) wanted to improve and streamline communication between GPs, specialists, and any other health providers involved in a patient’s care with a view to providing the right care at the right place quickly and efficiently.

Action

We provide a comprehensive Referral Management Service (RMS) for the CCGs as an effective approach to manage, complete, direct and monitor planned patient referrals throughout a health population, involving primary care, CCGs and providers.

The RMS works with clinicians and patients via an integrated referral gateway and personal contact. Upon receipt of the referral or triage outcome we directly contact patients to offer choice and book appointments at the most appropriate provider or return to the referring GP if clinical triage advises an alternative pathway. This helps to ensure that patients are referred to the right place quickly and are advised and involved in the process. The gateway ensures all stakeholders have real time information on the outcome of the referral. GPs are then able to dedicate more time to providing direct care.

Referrals are made electronically, using a standardised form containing patient history which, where appropriate, can undergo clinical review. This provides secondary or community care providers with a better quality referral letter, helps to reduce inappropriate referrals and supports the specialist clinician in providing valuable clinical information electronically.

Referrals can be made instantly and in most cases, even after triage, appointments are booked within 48 hours. Long-term GP referral patterns have been improved through identifying and supporting areas of educational need and through constant feedback either individually or collectively through peer review. Data retrieval has been improved to inform commissioners of collective referral patterns. The service provides an audit of a patient’s pathway up and until the appointment is booked with the secondary care or community care provider.

Patients receive written confirmation of any bookings and are better informed through advice and guidance. Referring GPs are also fully informed electronically.

Testimonial

All of the CSU team were excellent in the lead up to and go live of RMS and the day to day operation. We feel that the whole team worked constructively and coherently to shepherd us through the development and implementation stages. 

The team are never too busy to help, they work across and support all of our practices successfully troubleshooting by phone and logging in to systems. 

The team have engendered confidence in all of us and this is evident in that GPs have agreed to give them access to their systems. The team always looks at our issues with a view to taking responsibility to solve them to make things better for us and to develop their service. We have grown together over the last 18 months – learning from each other, for example we collaboratively developed a patient experience survey which has now been implemented at CSU – and is showing excellent results.

At the outset we had to overcome challenges in getting other stakeholders to accept our new system and the team played a pivotal role in this, they answered questions from outside organisations and met with colleagues to build relationships and now have very positive relationships across the health economy.

The system has now been in place for 18 months but the service we receive from the team has not wavered despite them expanding to cover other CCGs, we meet quarterly and have regular correspondence in between times if needed. We set a series of challenging KPIs when the contract was put into place and they have all been met consistently. 

The team are amongst the most knowledgeable about their own services that I have ever worked with and we are able to trust them.

Ruth Hunter – Head of Planned Care St Helens CCG

Contact information 

Julie Cornwell, Programme Manager, Referral Management Centre 

Tel: 01772 325041      Email: j.cornwell@nhs.net