Dr Peter Fink explains why the referrals management system in Manchester could be used as a model for the whole country.
For any individual GP, it is quite a challenge to remain abreast of all the potential services, make best use of scarce NHS resources and find the most appropriate service for their patient.
Manchester has a very complex system of different providers for out-of-hospital care. There is a range of intermediate level services provided by a mixture of local GPs with special interest and community services, which has been in place for more than five years. There is also a wide range of CATs services, commissioned by DH, which have separate entry criteria.
The NHS Manchester referral gateway's primary aim is efficiency: ensuring the patient is seen in the most appropriate setting in a timely manner to meet their healthcare needs.
The way this particular gateway has been established means local GPs remain at the heart of the decision-making process, but have the added advantage of back-office support provided by Harmoni.
The Harmoni administrative team that initially records referrals is based in Southampton, but the part this team plays in the gateway, whilst important, is not geographically determined.
The team uses pathways which is an electronic database of local pathways owned and version-controlled by NHS Manchester, with frequent input from Harmoni as the main user of the system. Secondly, the team uses the Manchester List which shows which procedures are available to patients and which procedures have not been commissioned by the PCT. Armed with this information, the location of the admin team becomes of secondary importance to its ability to maintain ongoing communication with NHS Manchester commissioners and the GPs it serves.
Referrals are reviewed and signposted to local specialist clinicians within an agreed time frame, currently 48 hours. The clinical triage, including much of the governance arrangements, takes place in Manchester and is run by GTD Ltd, a local provider of out-of-hours and primary care services. Local GPSIs have been contracted by GTD to assess the referrals for their speciality. Their role is to determine whether the patient could continue to be managed in primary care with the advice and support suggested by the triager, or whether a referral to Tier 2 services, ICATS or secondary care is more appropriate. Where referrals are returned to the referrer with further advice, an active dialogue takes place between the referring GP and triager who, together, work to agree the appropriate management of the patient.
With triaging GPs focusing on their own specialism, they are able to bring their in-depth knowledge of the various services to benefit Manchester patients.
Feedback from referring GP's, the triagers and the Harmoni team is helping to inform, improve and clarify local pathways for patients, helping to make the patient journey more efficient.
All IT processes are compliant with the current NHS Information Governance standards with data transmissions over N3. The non clinical staff provide back office support. We have also been mindful of the Kings Fund recommendations in developing this gateway.
Feedback received from a local GP regarding advice from the urology GPSI, 'many thanks for this information. Very useful. I'll pass this onto my colleagues as we all seem to have learning needs on this issue.'
Dr Peter Fink is a GP in Manchester and director of GTD Ltd
Dr Peter Fink
