What is the future for referral management centres? In this article, we argue that (i) the demand for referral management will accelerate as CCGs are forced to prioritise ‘where to spend the money’ and (ii) that technology and automation is the only way to deliver low-cost, fair and consistent referral management services.
Initially the focus of referral management was primarily to facilitate patient choice and make life a little easier for the GP. In the past five years the focus has turned decisively towards reducing costs – both containing cost of secondary care and reducing the costs of delivering the actual referral management services. A recent headline in the HSJ provides food for thought in terms of the future of Referral Management:
“A third of CCGs consider limiting access amid cash squeeze”
According to a survey conducted by the HSJ (21 April 2015), more than a third of clinical commissioning groups are considering introducing limits on access or eligibility for services this year amid huge financial pressures. Examples of new curbs range from limiting IVF services to access to procedures based on aspects of a person’s health such as smoking or obesity which can affect outcomes. CCGs are also considering measures such as extending limits on “procedures of limited effectiveness”, introducing clinical thresholds of need for some operations, and requiring prior commissioner approval for more operations. Read HSJ article.
The Referral Management Hub: The only way to control access?
What are practical steps a CCG can take to ensure effectiveness of secondary care or limit access as described above? It is theoretically possible to ask GPs to self-manage their referrals; however, the process of referral management is likely to become more complex. Yes, the traditional GP in a rural area is likely to have a good understanding of available local options, but he or she is will find it increasingly hard if not impossible to stay on top of ever more complex eligibility criteria and an evolving provider landscape.
In our view, the job of referral management can only be solved fairly and consistently by the use of referral management hubs or centres. In order to achieve scale of operations, these hubs are likely to be regional or super regional. In the future we also expect to see a dramatic acceleration in the use of technology and automation of referral management both to reduce operating costs and to increase the consistent application of ever more complex rules tailored to the individual health economy.
Automating Referral Management
In the past referral management centres have been criticised for high operating costs which then reduce the net benefit of such a service. New use of technology offers a number of benefits, the most important being dramatic cost reduction, consistent application of local ‘rules’, speed and better management information.
In many parts of the country, referral management is run manually. In the most extreme, referral letters are posted to the centre, envelops opened and an administrator will read the letter and decide if the referral is appropriate or where to send the patient.
How does it work in the world of automation? The GP makes a referral either on C&B or emails a document to the centre. An automatic triage engine interprets the C&B entry/email and automatically suggests a pathway based on complex rules. The net cost of automation should be 50 to 70% less than a manual service and see a significant improvement in consistency and data collection.
About psHEALTH – Intelligent Care Delivery
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