How we cut back on referrals administration
Dr Stuart Eastman explains how his referral system standardised referrals and reduced the paperwork they involved
Sarum CCG in Wiltshire has a relatively affluent and fit population, however, benchmarked against other areas, referrals to secondary care are higher than average. We already have special interest GPs in our area that can do minor surgery in the community, treating conditions like basal cell carcinoma, carpal tunnel syndrome and performing vasectomies. Treatment in the community costs us much less, is often more cost effective, timely, and convenient for patients. We wanted to find a way to make sure GPs were referring the right way and to the right people, and taking advantage of local clinics and services.
We have good relations with our local hospital and have many referral forms (some with referral guidance) for a wide range of specialities but managing the admin of referrals forms is a problem for us. The forms have to be uploaded to each computer in our patch.
For example, if a fax number for an oncology unit changes, we have had to send all the GP practices a new form, and expect them to upload it to their computers. We really needed a more efficient way of handling this admin.
Previously, automated referrals projects had fallen through, either because the products didn’t integrate seamlessly with our GP IT system, or because the roll-out following purchase was unsupported. We decided to use the Map of Medicine to create local pathways for common conditions, and we agreed to pilot their new referrals tool, which linked the process of making referrals to the pathways.
What we did
Our first step was to pilot it with four practices, over seven sites and with 55 authorised users. These users ranged from primary care clinicians and practice managers to IT practice leads and medical secretaries. Map of Medicine referrals was integrated into the TPP SystmOne GP system. A total of seven clinical pathways were locally tailored. Local referral form templates were configured and linked to pathways and local patient information leaflets. Map of Medicine provided face-to-face training, and support for local IT teams.
In the pilot there were some minor technical problems. We are now in the process of rolling out the system to all the GPs in the area, and the biggest challenge will be engaging everyone to use it. So far, we have held one session for GPs to explain how the system works with 90% of GPs in attendance.
Some of the efficiencies include having instant access to the tool through a sidebar on the desktop of a computer. From the pathways, you can get the latest form, which automatically merges patient details that are being displayed in the patient record. We can be confident that GPs are using the latest forms because we upload them centrally. It has reduced our admin, in terms of clicking through the different systems, and searching for forms.
Over 70% of the pilot practices reported having a positive experience and 80% said it enhanced clinical decision-making. Although it is too early to measure, potentially it could reduce overall referral cost.
We are rolling the solution out to all the practices in the CCG, and will need to support and encourage them all to use it properly. We want to localise more pathways and prove that we are standardising our referrals.
Dr Stuart Eastman is a GP in Salisbury. Corby Thomas is the IT manager for Sarum CCG