Mr Adler, chief executive of University Hospitals Leicester Trust, has accused providers in the South East of poaching patients from its congenital heart disease department. His view is that other providers have been able to offer the service for ‘nothing’, or at a heavily subsidised rate.
With the trust receiving fewer referrals the department is at risk of not fulfilling requirements set by NHS England, which specify a congenital heart surgeon must perform a minimum of 125 operations a year in order to maintain competence. Consequently, the trust is at risk of having the service decommissioned altogether.
Mr Adler suggested that the only way in which the trust could reach the minimum threshold was by commissioner changes to referral pathways. A notion that was rejected, on the grounds that it would violate patient choice.
This raises an important question: how do you manage demand, ensure patient choice, and utilise provider capacity effectively?
Single-Point of Access (SPA)
By implementing a SPA commissioners can ensure that all referrals within a given health economy are treated consistently, including Consultant-to-Consultant referrals (C2C). That is to say, patients are offered appropriate advice about possible services. Moreover by providing this service outside of a GP consultation or hospital appointment we mitigate against possible variation in referrals.
One of the issues facing Leicester trust, as commented by Mr Adler, is the number of referrals from the region being sent directly from paediatric consultants to providers in the south. There is no suggestion that this activity is inappropriate, however, what is not clear is whether Leicester’s department could have provided the same service, possibly with a shorter waiting time. By using a SPA the responsibility of keeping up to date with available services and waiting times is directed away from GPs and consultants, enhancing their time to make clinical decisions.
Typically a SPA is introduced by commissioners to manage demand and increase pathway control, in particular where they want to ensure take-up use of new community services. Conversely they provide a vital mechanism for protecting valuable local services. A SPA itself does not guarantee use of a particular service, though it can encourage it where appropriate. It does however facilitate the collection of referral data that can be used to explain why one service may consistently be overlooked. Therefore, rather than decommissioning a service immediately, constructive analysis can take place. Using this analysis to feedback to providers is central to service redesign.