Referral Compass

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15/10/2023

Why we started

Problem statement:

GP Practice lead spends 90 minutes a day managing referral failures to improve the chance of the referral being accepted.

What we want to learn:

We want to identify the key pathways in which there is the highest referral failure rate and what stage in the failure occurred.

Our hypothesis:

Through service redesign and digital intervention we can reduce the administrative burden on clinical and clerical staff, and increase the success rate of referrals.

The cost of the problem

1. Time - could have more appointments
2. Delays in treatment
3. Patient anxiety

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Risk vs Frequency

HIGH RISK, LOW FREQUENCY

LOW RISK, HIGH FREQUENCY

High Risk pathway

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Patient diagnostic and referral journey:

1. Patient presents with symptoms and is identified of being at risk of lower GI cancer
2. For an appropriate referral the 4F’s must be conducted:
1. Ferritin
2. Full blood count
3. FIT test
4. Finger test (DRE)
3. For the referral criteria to be met the patient must have all the 4F’s recorded to do a referral

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Lower GI cancer pathway example

Patient referral workflow - unsuccessful

Patient seen by doctor

Doctor concerned of a lower GI cancer and requests test (4F’s)

Admin staff submit request to ERS

Patient updated and referral is restarted (and further patient appointment if required)

Patient completes FIT test and blood test within 2 weeks

Admin check ERS, no update

Admin check ERS, and referral is rejected due to missing test/tests not being completed on-time/ inappropriate referral

Patient sent SMS to highlight no update

Patient referral workflow - unsuccessful

Patient seen by doctor

Doctor concerned of a lower GI cancer and requests test (4F’s)

Admin staff submit request to ERS

Patient updated and referral is restarted (and further patient appointment if required)

Patient completes FIT test and blood test within 2 weeks

Admin check ERS, no update

Admin check ERS, and referral is rejected due to missing test/tests not being completed on-time/ inappropriate referral

Patient sent SMS to highlight no update

Next steps: Collecting data

Link

1. Test with 2 Leicester doctor surgeries (5,000 patients)
2. Call with patient service advisors to explain spreadsheet
3. New workflow to test impact on patients

Future: clerical UI

Design required to develop a user interface for clerical staff to input referral data and why rejected

Future: patient UI

Interface with patients

Proposed website:

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Link

What we recommend and next steps

• Understand high risk / frequency referral failure pathways
• Create a data driven approach to collect this data
1. Identify the stages where referrals go wrong
2. Develop solutions / educational documents around these pathways and inform locums / GPs / advanced nurse practitioners / clerical staff on these issues
• Provide patients with updates on referral
• Test if by providing patients with updates, does this reduce:
• Anxiety
• In-bound communication
• Improves patient satisfaction and care
• Potential next steps:
• Create a UI which integrates with the NHS app to provide referral updates for patients
• Create a UI for clinical staff to effectively monitor referrals (uplift of the spreadsheet)
• Create a mechanism for reporting on referrals at a PCN level
• Reducing / replacing the need for existing reporting