We accept the value of its aims but suggest that effectively deployed referral systems -whether they be management or support services – that overcome fundamental management challenges, naturally address service issues.
Referral Management or Referral Support?
‘Referral Management Centres, which are primarily designed to reduce GP total referral numbers to hospital should not be introduced’ (RCGP Feb 2018). Instead, the RCGP presents the case for initiatives which are ‘primarily designed to improve referral quality… termed Referral support’.
The RCGP views referral services primarily aimed at reducing referrals as counter-intuitive, citing evidence that patients will arrive in secondary care via another route anyway. Comparatively, a service primarily aimed at improving referral quality – employing programmes like Advice & Guidance – should naturally affect the volume of GP referrals received by hospitals so long as it is delivered effectively.
However, if the service is poorly designed or under-resourced then it is unlikely to achieve either objective. Standard service specifications include a wide range of aims which on paper appear achievable, but all too often they are constrained by a familiar set of challenges:
- Limited budget
- Recruitment challenges
- Staff retention
- Short term contracts (many pilots extended on a year by year basis)
- Unsuitable technology
How to address these challenges?
Challenges 1-3 are present in most settings across the NHS. Debating budget here is unlikely to reveal anything new. Likewise, resourcing and contract terms are difficult issues to consider without analysis of individual services e.g. considering their geographic location or understanding local commissioning intentions.
Instead, we should consider how these issues can be influenced by practical changes on the ground. The question of technology is an interesting one. Although it may reasonably be positioned at the bottom of the list, the ability to relieve financial and resource pressures cannot be overlooked.
Referral Services* have a choice of technology that extends beyond email inboxes and the NHS e-Referral Service. It also extends beyond repurposing a clinical system or falling back on an Excel spreadsheet.
While these options provide an adequate way to deliver a Referral Service, they do not enhance it. Moreover, they require substantial management – by clinical and administrative staff – the like of which requires funding.
In short, they are not explicitly designed for Referral Support or Referral Management. So why not consider a solution that is?
ART – Advanced Referral & Triage – has been developed with a narrow focus, closely aligned with the aims and specification of Referral Support Services. By understanding these aims, and factoring them into our thinking, we’ve gone some way to addressing them before a customer even begins using the system.
ART combines powerful automation technology with an intelligent Rules Engine – enabling the solution to complete manual tasks – like transferring referral attachments between systems.
In addition, through the use of the Rules Engine, ART automatically extracts key referral information and can identify referral specialities and reasons. Then, by consulting service guidelines ART can apply a rule which directs the referral to clinical triage or automatically shortlists by connecting to e-RS. All activity is recorded and users have access to a full suite of reporting dashboards.
Technology, focussed on a defined set of use cases, can vastly improve the effectiveness of a Referral Service.
For many Referral Services, too much time is spent ‘handling’ referrals, without adding real value. By this we mean time spent copying data or transferring referral documents between systems. Work that can be automated or more effectively completed with the right technology.
With ART, Referral Services can focus on introducing initiatives designed to improve referral quality, in a safe and cost effective manner. Doing so successfully will impact directly on the volume of referrals received in secondary care settings.
*Referral Services – used here to describe either Referral Management or Referral Support Services
RCGP calls for an end to referral management centres that ‘prioritise cost-savings over patient care’ (RCGP, Feb 2018)