Peer review and the future of referral assessment

In August, Pulse reported that NHS England had written to CCGs in May, asking them to implement weekly clinical peer review of all referrals from general practice by September 2017.  Financial rewards would be given to regional teams introducing schemes to enable CCGs to deliver a slower growth in referrals.

Despite more than half of CCGs already having some sort of peer review system, with peer review in Luton showing an 8% drop in hospital referrals, for example, the proposal created a storm.  This may have been exacerbated by the apparently secretive nature of the directive.

Amongst other reservations, GPs were concerned about possible indemnity implications, the associated additional workload and one GP, who had previously undertaken peer review stated, “What I found out was that it was practically impossible to change someone’s referral habits”.

The General Practitioners’ Committee (GPC) also had misgivings.  It felt the proposals outlined in the NHSE ‘Clinical Peer Review’ document “risk undermining professionalism and damaging the trust that must exist between doctors and patients”.  It maintained that any scheme should have at its heart “the primary aim.. to improve patient care and not to reduce activity”.

Dr Andrew Green, of the British Medical Association’s general practitioners committee, said forcing GPs to have an hourly meeting once a week to discuss referrals would be the equivalent to removing 1,000 GPs from the health service. (Mail Online:  29/08/17)

The backlash from the profession led NHSE to withdraw its proposals in October.

So where does this leave us?

For referral management systems to be beneficial for patients and supported by GPs, practitioners must be heavily involved in developing their governance policies and processes – but not necessarily their administration.

In our opinion, Single Points of Access offer the benefits of peer review, without the drawbacks:

  • They allow data to be collected on all referrals, not just those that have originated from GP peer review. This is particularly significant bearing in mind that recent statistics* show the growth in referrals is not GP-led.
  • They don’t significantly detract from GP time, allowing the latter to spend longer with patients.
  • They ensure that referrals follow pre-agreed and predetermined clinically appropriate pathways and that referrals are not unnecessarily delayed when documentation is not complete. This is not the same as reducing activity but managing where activity occurs.
  • They provide an additional service to patients – care coordination/ navigation.
  • Review is still clinically led, but more flexible in terms of what referrals to review and when

What we are doing

At psHEALTH, we’ve spent years fine-tuning our software to assist service providers, referral services and SPAs with the management of referrals.

By leveraging automation techniques and intelligent rules we’ve enabled our customers to focus on the areas of greatest priority – safe in the knowledge that majority of referrals can be processed as required without intervention.

One of our more recent clients is The Connected Care Partnership Vanguard, which includes the GP Federation Modality Partnership. Sapna Shannon, Director of Community Services at Modality, said “We’re especially excited that psHEALTH’s Advanced Referral Triage software will enable us to automate aspects of the Referral Facilitation Service, so releasing our staff to spend more time engaging with patients”.

* Data published by NHSE on 24th November also reinforced that GPs are not currently adding to the growth in referral rates.  From Q2 2016/17 to Q2 2017/18 the number of GP referrals made decreased by 21,663 to 3.48 million. The number of other referrals made increased significantly by 89,994 to 2.18 million.