The NHS England incentive scheme for CCGs, known as the Quality Premium (QP), will introduce several new measures in 2016/17. It offers rewards to CCGs for improvements in the quality of services they commission and for associated improvements in health outcomes and reduction of health inequalities. We at psHEALTH were pleased to see the ongoing commitment to monitoring patient satisfaction, but chiefly, we were encouraged by the inclusion of e-Referrals (e-RS). In this blog we consider the value of the QP to CCGs and provide evidence of where Referral Management Centres have contributed positively to the uptake of e-RS.
The QP will measure CCG performance on a national level, accounting for 70%, and on a local level, this year focussed on the Right to Care Programme, worth 30%. The national measures are broken down into four sections: cancer (20%); GP Patient Survey (20%); Improved antibiotic prescribing in primary care (10%); and, e-RS (20%).
The NHS e-RS service, implemented in September 2015 as a replacement for Choose & Book, got off to a bumpy start – see our blog. However, HSCIC has worked hard to iron out initial teething issues and now the key challenge is to increase usage.
Current uptake of e-RS varies significantly around the country. Some CCGs have reported that a majority of GP referrals are made via the service but in other places efax and email continue to dominate. To receive the QP incentive for this measure, CCGs will need to either:
- Meet a level of 80% by March 2017 (March 2017 performance only) and demonstrate a year on year increase in the percentage of referrals made by e-RS (or achieve 100% e-RS), or;
- March 2017 performance to exceed March 2016 performance by 20 percentage points.
Increasing the level of referrals made via e-RS is central to delivering a paper-free NHS, but more importantly it offers tangible benefits to patients, GPs, providers and commissioners.
There are a number of good examples where the introduction of a Referral Management Centre (RMC) has led to significant take-up of e-RS and indeed some CCGs have used RMCs as the mechanism for driving usage.
Croydon Referral Support Service (CReSS) is an excellent example of the results that can be achieved when using a RMC. Working in Croydon, CReSS, supported by psHEALTH solutions, has successfully driven the percentage of referrals made via e-RS from single figures to 99%.
When CReSS instigated referral management in Croydon, the majority of the practices were on board, with a few exceptions. Antony Clark (Development and Liaison Manager, CReSS) explained that through a series of GP visits and forums, they were quickly able to reassure sceptical GPs of the benefits. Antony commented that the process of convincing GPs was made easier by the fact that all specialities could be referred by e-RS.
In addition to increasing the usage of e-RS at the point of referral CReSS has reported improved use of e-RS at the point of booking. Of the referrals appropriate for secondary care, the majority are now booked via e-RS (65% in February 2016).
For CCGs looking to meet the QP requirements, increasing the uptake of e-RS is a feasible target, one that can be facilitated by the introduction of a Referral Management Centre. It will be interesting to see how many CCGs adopt this approach and what level of success they achieve.