RTT targets temporarily relaxed? Time the NHS reviewed its referral systems

This Spring, the financial penalties for providers who fail to reach the target of 92% of patients being seen within 18 weeks of referral for consultant-led treatment (RTT) seems, temporarily, to have been removed.

This appears to have been a recognition by the Government that for financial and demographic reasons, for many trusts the target just wasn’t achievable.

As recently as the end of May 2017, 90.4% of patients waiting to start treatment (incomplete pathways) were waiting up to 18 weeks, thus not meeting the 92% standard (NHS England).  The last time the standard was met was in fact February 2016.  Moreover, NHS England’s Operational Information for Commissioning, June 2017, stated of incomplete pathways “Since April 2012, the RTT waiting list has been at a higher level each month than the same month in the previous year”.

Partially, the RTT measure downgrading also reflects a change in Government priorities:  these are stated in the Next Steps on the NHS Five Year Forward Review (March 2017) as improving A&E, access to GP services, cancer services and, mental health.  The document highlights the desire to ‘join up’ care, reiterated by NHS England’s Chief Executive, Simon Stevens, in his speech to the NHS Confederation in June, “We are now embarked on the biggest national move to integrating care of any major western country” breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.

The ‘Next Steps’ document also strongly encourages CCGs/Trusts to look at their referral pathways, rather than solely RTT statistics.

“Analysis.. shows very large variations in the number of patients being referred to hospital outpatients, being followed up repeatedly in outpatients and receiving elective operations. These variations cannot be explained by differences in health need and are often present between different GPs in the same area and different doctors in the same hospital.”

During 2017/18 CCGs and trusts will also step up their work to get more value out of the NHS’ investment in elective care.

  • For GPs and CCGs this will mean tackling clinical practice variation in referrals
  • For trusts this will mean tackling variation in clinical quality and productivity
  • For CCGs and trusts jointly it will mean redesigning care pathways to promote optimal patient care
  • CCGs will review their referral management processes and guidance, where appropriate redesigning patient pathways

These principles are reiterated in the NHS Operational Planning and Contracting Guidance for 2017-19, where objectives include to “Streamline elective care pathways, including through outpatient redesign and avoiding unnecessary follow-ups.”

Many CCGs appear to believe that Referral Management Centres (RMCs) offer the best prospect of pathway control.  The British Medical Journal states that as of January 2017, there were 93 referral management schemes in operation across 72 CCGs, with some CCGs having more than one scheme. And the number appears to be growing.

The effectiveness of such RMCs, and Single Points of Access, must be in large part down to the quality of the systems – and technologies – put in place, however.

Connected Care Partnership is a multispecialty community provider vanguard in Birmingham and Sandwell.  It will be introducing a new Referral Facilitation Service, which in line with Next Steps on the NHS Five Year Forward Review, aims to offer more alternatives to hospital care, specialised care closer to home and to help local people manage their health confidently.

psHEALTH’s software solution for CCP not only facilitates the referral process but also enhances it by integrating with key systems and automating manual steps.

Sapna Shannon, Director of Community Services at Modality (forming part of CCP), said: “Our focus is on improving the way health and care is delivered across the CCP population. We believe that by working with psHEALTH we will be able to achieve our goals in an efficient and innovative way”.

Josh Murray, Partnership Manager at psHEALTH says, “We have developed our systems to eliminate manual processes and ensure that referrals are automatically forwarded to the right department.  Significantly, however, our software also produces real-time metrics and reports, ensuring improvement and refinement of care pathways and local commissioning advice based on evidence.”