How South London CCGs avoided thousands of referrals

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Case Study Summary
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Overview summary:
Four years ago Wandsworth CCG embarked on their Referral Management Programme and chose Kinesis as one of the core elements supporting it.
In 2015 Kinesis was used to seek advice on 3639 patients by GPs from across the CCG. The advice they received from specialists at their providers resulted in 1700 of these patients avoiding an outpatient referral & receiving faster access to appropriate treatment. They also saved over £300,000 in referral costs. Since then 6 further CCGs to adopt Kinesis and are beginning to see the same benefits.
Challenge identified and actions taken :
The average cost of an outpatient clinic referral is around £204.
In 2009 the problem associated with increasing referrals was reported by NHS Institute for Innovation & Improvement (Delivering Quality and Value - Focus on: Productivity and Efficiency. April 2009); evidence presented showed that “up to 65% of patients attending outpatient specialty clinics are discharged with no significant pathology being detected”.
NHS Midlands & East reported (Confer: End of Pilot Report 2012) “marked and ongoing increases in outpatient referrals” (13% during 2008/09 HES online) and discussed the demand management challenge for primary care commissioners and acute trusts. The trend has continued with 13.6m GP referrals in 2015, a 5% rise on the previous year.
Continued pressure on outpatient clinics due to increased demand, and the necessity of decreasing the time to appropriate treatment in order to minimise health costs and maximise clinical outcomes lead some organisations to wonder if there were better ways of supporting GPs when making referral decisions.
A Kings Fund Report concluded that supporting GPs in their practice to make better referral decisions was the best way forward (Referral Management – Lessons for Success. Candace Imison and Chris Naylor, Kings Fund 2010).
Introduction of Kinesis has begun to adress this
Impacts / outcomes:
Since adopting the programme was a CCG now have 5 providers supporting over 40 specialties. All GPs in the area are able to request advice about a patient using a secure but simple browser-based application and expect to receive a reply within a day.
Wandsworth are on target to make over 4000 requests for advice this year with 58% of these resulting in a permanently avoided outpatient appointment.
6 further CCGs have adopted the same approach and are beginning to see equally positive results.
Where patients do need to be referred, this is often to the correct clinic with the right information and tests having been completed and, in some cases, an expedited referral since a specialist has effectively triaged the referral and is expecting this particular patient.
The benefits are not restricted to time-saving and cost saving. Patients benefit from greater reduced waiting times for appointments and treatment, and mostly benefit from continuing to be treated in primary care without a burdensome trip to hospital. GPs have responded I favourably to the system and report significantly improve care and treatment options for patients as well as being able to build relationships with their secondary care colleagues. They also report increased knowledge and confidence in their referral practice and this is reflected in the referral data. Meanwhile the specialists avoid their clinics being burdened with unnecessary referrals, ensuring they can spend more time with patients with greater needs; they also report enhanced relationships with their primary care colleagues and the ability to pass on their knowledge and expertise.

The experience at Wandsworth CCG is a sustained 5 to 1 ROI can be achieved within two years, based on avoidance of referral tariffs alone. It is believed (as suggested by the CCGs) an equal amount of savings are experienced across the health economy in terms of improved clinical outcomes, but this is not be objectively measured.
Supporting quote for the innovation from key stakeholders:
  • and there’s now an opportunity for us ALL to benefit from the recent progress
"It's a very well designed and easy to use system that bears no relationship to typical NHS IT"
Sarah Thurlbeck, Consultant Paediatrician, St Georges Hospital
"I think you have an impressive system in Kinesis. It's simple and intuitive and  really makes a difference."
Mike Conlon, Service Redesign Manager, Sutton CCG
"the issue isn't really about these savings, it's about the improved patient care…"
Dr Nicola Jones, chair Wandsworth CCG
Which local or national clinical or policy priorities does this innovation address:
Referral management and reducing time to treatment
Plans for the future:
We are in ongoing discussions with eRS to integrate Kinesis once they have released the APIs that will allow this. We are also aiming to integrate directly with the main primary care systems to make it even easier for GPs to request advice when required.
In the longer term we are looking at using machine learning to provide even quicker suggestions based on the responses from specialists.
However our main goal is to drive up the number of CCGs and GPs using the system and to increase the number of times they seek a conferral rather than a referral.
Tips for adoption:
  • Ensure that you have a dedicated programme manager - change management is harder than technology.
  • Get the support of your local seconary providers - the CEO is good to have on board, but equally find some individual specialist who really want this to work
  • Chase down any requests for advice that take longer than a couple of days to receive a reply - GPs need to have faith in the process.
  • Feedback to users on how much good it is delivering
Contact for further information:
or call Simon Hudson on  0773505295
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