Increase in Activity – Referrals (HUH)   GP Non GP Total 2017/18-Apr to July 13547 7270 20817 2018/19-Apr to July 13321 8562 21883 Change in Activity % -226 1292 1066 -2% 18% 5% Some coding may have changed due to eRS implementation which may indicate GP activity is about the same as last year ‘Other’ referrals therefore the main cause of 900 + extra in 4 months Possible £1.6 million over plan in outpatients by end of the year Includes follow ups, procedures etc

Growth in non-GP referrals Other' Referrals Activity Variation Apr - Jul % Variation Comment Top 10 Specialties (HUH) Apr - Jul 2017 Apr-Jul 2018 Paediatrics 602 829 227 38%   Homerton Day Case Tops 36 193 157 436% Switch in coding from GP to AHP General Surgery 300 442 142 47% Colposcopy 81 304 223 275% Switch in coding from GP to NSP Cardiology 231 384 153 66% Accident and Emergency 711 806 95 13% Trauma & Orthopaedics 1702 1794 92 5% A & E/C2C increase in referrals Gastroenterology 553 601 48 9% Was higher - fell in July Thoracic Medicine 456 501 45 10% Breast Surgery 96 125 29 30% AHP – Allied Health Professional eg Community NSP – National Screening Programme

Areas of GP referral growth GP Referrals Activity Variation Apr - Jul % Variation Comment Top 8 Specialties (HUH) Apr - Jul 2017 Apr-Jul 2018 Gynaecology 1354 1813 459 34% EPAU/Hysterescopy Breast Surgery 831 938 107 13%   Trauma & Orthopaedics 689 755 66 10% Gastroenterology 801 908 Rheumatology 256 313 57 22% Care of the Elderly 182 228 46 25% Paediatric Cardiology 16 47 31 194% Urology 776 25 3%

Increases in Daycase activity Elective daycases over plan by 14% or £285k Highest increase procedures: HUH Procedure - Daycase - Apr - Jun 2017/18 2018/19 Variance % Comments Diag.Endo.Exam/Lower Bowel Using Fibreoptic Sigmoidoscopy 147 288 141 49% Diagnostics - Gastro Diagnostic Endoscopic Examination of Colon 178 270 92 34% Endoscopic Extirpation of Lesion of Colon 105 130 25 19%   Endo.Extirp/Lesion/Lower Bowel Using Fibreoptic Sigmoi 34 49 15 31% Diagnostic Fibreoptic Endoscopic Exam/Upper Gastrointe 409 485 76 11% Other Operations on Oesophagus 11 27 16 100% Introduction of Abortifacient into Uterine Cavity 84 209 125 60% ToPs - We now have BPAS and HUH Other Evacuation of Contents of Uterus 179 206 13% Totals 1147 1664 517 Note: Increases in daycases also at UCLH

Homerton Action Plan We have developed an action plan to help us address these issues The plan includes actions on: Analyse C2C and non GP referrals to identify if increases are due to seasonal trends or growth. Are source coding changes due to e-RS implementation or not Audits of hysteroscopy, colposcopy, general surgery Audit C2C activity against the protocol criteria – this includes: In the event of a Consultant to Consultant referral the referring Consultant should inform the patient’s GP of the referral and the reason for it.’ Review paediatric and maternity data Early Pregnancy Assessment Unit – examine reasons for increases

What else can we do? How GPs can help? Next Steps What else can we do? How GPs can help?