referral management & choice tower thistle, london 13th may 2004
TRANSCRIPT
Referral Management & Choice
Tower Thistle, London
13th May 2004
The Role of the RMC in Systems Reform
The Wakefield West PCT Referral Management Centre
Background • History of waiting list and waiting times problems
• Identified capacity gap
• Financial Control Plan
• Referral levels comparable with benchmark
• Need for demand management, alternatives to secondary care, increased capacity in primary care, protocols and guideline
• Poor referral information
• Emerging policy on Booking and Choice
Referral Information
• No regular, timely, detailed information available
• QM08R not at practice /gp level
• No information at sub specialty, consultant, or reason for
referral level
• Local provider data on request but 6 months out of date
• No other provider data
Intended Benefits of the RMC
• Accurate and timely referral information available within the PCT in order to understand demand
• Accurate and timely information to feedback to practices to raise awareness of own referral patterns and comparative referral patterns (numbers, per 1000 population, deprivation scores
• Information on referrals to all providers
• Information on which to assess potential of GPwSI developments and to scope GPwSI services
• Early identification of referral patterns – peaks in referrals leading to peaks in waiting lists, shifts to other providers
Intended Benefits of the RMC cont/…
• Opportunity to influence referral patterns
• Opportunity to monitor referral guidelines
• Information on which to review commissioning decisions and assess impact of PBR
• Possible use of information to look at equity of access issues
• Potential to book appointments for GPwSI services.
• A central contact point for patients to enquire about a referral and reduce calls to general practice
• Potential to book outpatient appointments
• Potential to facilitate patient choice
Initial Scope• To receive and log all routine GP referrals, for outpatient consultation, to
secondary care
• To receive and log copies of urgent cancer and RACPC referrals
• To provide monthly and quarterly referral reports to PCT and to general practices
• To monitor activity against SLAs
• To monitor implementation of guidelines
• To answer patient queries o the progress of their outpatient referral and average waiting times for first outpatient appointments
• To inform developments in demand management
• To inform development of GPwSI services
Referral Management & Choice
Tower Thistle, London
13th May 2004
Referral Management Centre- what does it do?
Dr Mark Napper
Medical Director
Current Functions of Referral Management Centre
Accurate and comprehensive data on GP referrals– Analysis by practice, provider and
speciality– Analysis by presenting problem– Trend analysis– Reports fed back to practices
Provider analysis
Quarter 3 referrals per Trust
TrustNumber of referrals
% of total referrals
Barnsley District General Hospital NHS Trust 6 0.1Bradford Hospitals NHS Trust 7 0.1Chapel Allerton Hospital 1 0.0Doncaster and Bassetlaw Hospitals NHS Trust 1 0.0Huddersfield NHS Trust 42 0.7Leeds Teaching Hospital Trust 140 2.3Marie Stopes 6 0.1Mid Yorkshire Hospitals NHS Trust 5912 96.5Royal Hallamshire Hospital 1 0.0Royal Oldham Hospital 1 0.0Sheffield Teaching Hospitals Trust 2 0.0St Lukes Hospital 1 0.0York Health Services NHS Trust 1 0.0Calderdale & Huddersfield Hospitals NHS Trust 1 0.0Thornbury Hospital 1 0.0Huddersfield Nuffield 1 0.0Harrogate Health Care NHS Trust 1 0.0Total 6125 100
Analysis by Speciality
% of total referrals
0
2
4
6
8
10
12
14
16
18
Gener
al S
urge
ry
Ophth
almol
ogy
ENT
Urolog
y
Plastic
Sur
gery
Cardio
logy
Gener
al M
edici
ne
Rheum
atolo
gy
Respi
rato
ry M
edici
ne
Geriat
ric M
edici
ne
Nutrit
ion
& Diet
etics
Pain M
anag
emen
t
Audio
logica
l Med
icine
Radio
logy
Nephr
ology
Orthdo
ntics
Clinica
l Gen
etics
G.U.M
Paedi
atric
Sur
gery
Med
ical O
ncolo
gy
Clinica
l Onc
olog
y
Rehab
ilitat
ion
Speciality
Pe
rce
nta
ge
Analysis by Provider and Speciality
Total
0
2
4
6
8
10
12
10
0. G
EN
ER
AL
SU
RG
ER
YL
EE
DS
TE
AC
HIN
G
11
0. T
RA
UM
A &
OR
TH
OP
AE
DIC
S
13
0. O
PH
TH
AL
MO
LO
GY
15
0. N
EU
RO
SU
RG
ER
Y
30
1.
GA
ST
RO
EN
TE
RO
LO
GY
33
0. D
ER
MA
TO
LO
GY
41
0. R
HE
UM
AT
OL
OG
Y
50
1. O
BS
TE
TR
ICS
81
0. R
AD
IOL
OG
Y
Total
Analysis by Provider and Speciality (2)
0
50
100
150
200
250
300
350
400
100.
GE
NE
RA
L S
UR
GE
RY
MID
YO
RK
SH
IRE
HO
SP
ITA
LN
HS
TR
US
T
101.
UR
OLO
GY
110.
TR
AU
MA
&O
RT
HO
PA
ED
ICS
120.
EN
T
130.
OP
HT
HA
LMO
LOG
Y
140.
OR
AL
SU
RG
ER
Y
160.
PLA
ST
IC S
UR
GE
RY
320.
CA
RD
IOLO
GY
502.
GY
NA
EC
OLO
GY
October 2003
November 2003
December 2003
January 2004
Number of Referrals by Practice
Numbers of referrals by practice - all Trusts
0
20
40
60
80
100
120
140
Total
Rate of Referral by Practice
Total referral rate per 1000 patients on practice list
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
A B C D E F G H I J
Avera
ge re
ferra
l rate K L M N O P Q R
Practice
Re
ferr
al
rate
Trend in Referral Rate by Practice
0
10
20
30
40
50
60
K O D Q H A C J I L
Ave
rag
e B F G R N P E M
Q4 Total
Q3 Total
Surgical Referrals
0
50
100
150
200
250
300
Cancer_FastTrack100. GENERAL SURGERY
MID YORKSHIRE HOSPITALNHS TRUST
Routine Soon Urgent
October 2003
November 2003
December 2003
January 2004
Dermatology Referrals by Presenting Problem
0 2 4 6 8 10 12
December 2003acne
December 2003Benign lesions
December 2003eczema
December 2003MOLE ON ABDOMEN
December 2003Mole on back
December 2003naevus
December 2003rash
December 2003skin tags
December 2003varicose ulceration
December 2003Lesion on forehead
December 2003Seborrhoeic dermatitis
Total
Current Functions of Referral Management Centre
• Responding to enquiries from patients, carers and practices
• Choice Cataract Pilot (patient care advice)
Current Functions of Referral Management Centre
• Choice at 6 months (patient care advice)
• Booking for Primary Care Musculoskeletal Service
• Intercepting referrals for services outwith commissioning policy
Referral Management & Choice
Tower Thistle, London
13th May 2004
Extended Role
• Booking of GPwSI Service
• Managing referrals to other ‘ gateways’
• Implementing process for Choice@ 6 Months
• Implementing process for Choice @ Referral Pilot in cataracts
• PCT management of potential 9 month waiters
• Identification and tracking of GSUPP 1 patients, management of referrals process
• Implementing Choose and Book
Choose and Book
• Will the national e booking system provide PCT level referral information of same level of detail from December 2005?
• What part of the Choice process will be delivered in general practice?
• What service will the NHS Direct Booking Management Service provide?
• What is the role of PCTs and how can they deliver it?– Selection of 5 providers – Levels of activity commissioned – Monitoring activity against SLAs– Monitoring capacity– PCT managed waiting lists – Informing Plurality – Central referral and contract management options
Choose and Book cont/…
• The development of more dynamic contracting is likely to require:
– Pooled contracts to share volumes across PCTs
– ‘Real time ‘ information on referral patterns
– Agreement on referrals and conversion rates
– Active management to switch activity around the system to meet preferences
• Different patients will require different levels of support in helping them choose –clinical and non-clinical support. - PCTs are expected to provide a range of support services appropriate to their local populations
Choose and Book cont/…
• Where electronic booking is not in place by December 2005 paper referral will have to be made and patients should expect to be able to book the time and date of their secondary care appointment within 1 working day of the referral reaching the secondary care provider. Alternative local arrangements will be required to support booking and choice in any areas without access to the Electronic Booking Service
• How will a national solution identify different streams of patients –e.g. ‘free activity’, national IS procurement activity, local IS procurement activity?
Referral Management & Choice
Tower Thistle, London
13th May 2004