Referral Support Service Navigating patients to the right care, right place, right time, first time Presented by Allyson Kershaw & Alex Couperthwaite Referral Support Service

The Story so far………………. The RSS was set up with the purpose of improving the quality of GP referrals to secondary care and gaining a better understanding of the demand for outpatient appointments. The service was designed to give GPs feedback on their referrals, and to provide the practices with timely information about their referral rates so that comparisons could be made against peer practices. The ultimate goal of the RSS was to reduce unnecessary outpatient appointments by ensuring patients are seen in the right clinic, first time.

The story so far…. The RSS team was established in July 2013 and has processed over 456,000 referrals in total for three CCGs Close working relationships have been built between the RSS administrators and GP practice staff Patient feedback about the service is consistently excellent 99.9% satisfaction rate The RSS has supported the implementation of the Health Optimisation thresholds.

RSS Website http://www.scarboroughryedaleccg.nhs.uk/rss-srccg Referrals are read and assessed by the RSS to establish if they meet criteria for referral to secondary care. All the different policies and criteria are on the RSS website.

Admin Triage The Reception area is the starting point for all RSS referrals Referrals are triaged against CCG guidelines Forwarded to clinical triage Forwarded to booking Returned to the practice The team responsible for admin triage process around 400 referrals a day.

Procedures Not Routinely Commissioned Some referrals require an accompanying information to show how the condition meets the specific referral criteria where treatment is not routinely commissioned by the CCG For Example Dupuytren’s contracture Hernia Repair Carpal Tunnel Syndrome Tonsillectomy Haemorrhoidectomy Varicose Veins Patients who are not eligible for treatment under these policies may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that justifies deviation from the rule of this policy. Individual cases are considered by the individual funding request panel (IFR)

Health Optimisation Proforma Must be completed for all surgical referrals Only applicable to over 18s Non-smoker with BMI <30 Hip & Knee or <35 all other surgical specialties:the rest of the form does not require completion Smoker or BMI >30/35 is this a referral for a surgical or medical opinion ? If medical e.g ENT referral for dizziness no further info required. If surgical - complete relevant box and provide current BMI & Smoking data. If any exclusion applies tick whichever applies If 6-month health optimisation period complete ensure the box is ticked Health optimisation applies even if IFR funding is approved for a procedure unless the funding approval is for exceptionality against the HO being applied.

Clinical Triage Triaged referrals (at present) Urology - female Gynaecology Neurology Dermatology (includes 2WW Skin) Rheumatology Orthopaedics  Actions for Reviewers Review Forward for booking Upgraded or downgrade priority Reassign speciality Return with advice Return requesting additional information If a referral is returned from triage back to the GP, this decision can be appealed by responding to the link in the email. This link can also be used to supply additional information or requested attachments to the reviewer. This maintains continuity of communication with the reviewer and speeds up the process. If the link is available and practices do not use it and instead create a new referral these will be returned. You have 20 days to use this link

Booking Stage Once the referral is forwarded to the booking stage the RSS team transfer the referral information onto e-RS and attempt to contact the patient 3 times, usually over a 24 - 48 hour period depending on the urgency of the referral We offer a choice of hospitals and appointment days/times to ensure the patient is satisfied with their referral journey If we are unable to contact the patient we send an NHS e-RS choices letter with an accompanying cover letter explaining how to book their appointment The team are extremely knowledgeable of local and some national specialist services

What makes a good referral ? ICG Proforma fully completed – clear and to the point with all relevant information about the referral reason and how it meets criteria All attachments are there and can be opened and read Correct specialty/clinic type selected for referral Correct phone number to contact patient Inform us of third party consent If IFR funding is required approval has been sought and letter attached Good quality photographs Up to date BMI and smoking status

Return reasons 2ww forms not fully completed 2ww form submitted inappropriately – not a 2ww if the criteria boxes can’t be selected. 2ww breast cancer form submitted rather than referring to Surgery breast - other symptomatic clinic Duplicates Health optimisation template not completed Health Optimisation criteria is not met Incorrect specialty and/or clinic types Missing attachments IFR prior approval required

NHS Paper Switch Off Programme New clause – Service Condition 6.2A of the NHS Standard Contract With effect from 1 October 2018, and as provided for in NHS e-Referral Guidance and/or any subsequent guidance published by NHS England and/or NHS Digital, the Provider need not accept (and will not be paid for any first outpatient attendance resulting from) Referrals by GPs to Consultant-led acute outpatient Services made other than through the NHS e-Referral Service.

What does this mean to you? With immediate effect paper referrals should not be submitted to consultant led first outpatient services that can and should be sent electronically via the RSS. The RSS can now book into named clinician slots where necessary via e-RS Over 120 paper referrals returned to practices in the last six months If you are sending paper referrals – WHY ?

Overview of the NHS e-Referral Service (e-RS) e-RS (previously Choose and Book) is an electronic referral and management system, using Spine information, that can integrate with other systems Background getting the patient to the right place, first time and without undue delay provides a secure environment to send patient information between referrers and providers enables on-line booking/management of appointments integrates with other systems, eg GP clinical systems and provider appointment booking systems What is e-RS about? Trainer Note: Background – Further explanation e-RS (previously Choose and Book) is an electronic referral and management system, using Spine information, that can integrate with other systems The Spine is a name used for where Patient Demographic Information (PDS) is held and can be accessed from. Integration with other systems includes referrers GP clinical systems, eg Emis, and provider Patient Administration Systems (PAS)/Appointment Booking Systems eg Lorenzo. e-RS is able to be dynamic and responsive to patient, clinician and NHS England requirements New releases of e-RS are now (usually) every 4 weeks. New functionality is developed, tested and installed in shorter timescales. Issues can be identified, fixed and uploaded more often. Problem solving has been brought in-house and is being managed by personnel with more knowledge of how the system is used than before.

A Patient’s Referral Paperwork Patients are sent paperwork with all the information they need to book an appointment, including: A Unique Booking Reference Number (UBRN). This allows patients to book/change their appointment. The UBRN is used by the service to access the referral. A password, which is also required to facilitate an appointment booking. Service/s details and information on how to book an appointment

How do patients get their appointment? The RSS calls the patient and makes an appointment for them Patients can book and manage their appointments on-line via the Patient Web Application (PWA) or by ringing The Appointments Line (TAL). Appointments will be booked straight into the clinic’s Patient Administration System (PAS), which also registers new patients. Any changes made in e-RS will be automatically updated in PAS and reflected in the patients referral paperwork. The provider will confirm the appointment with the patient

Importance of monitoring your e-RS worklists If a provider rejects a referral for any reason they reject it back to the GP via e-RS You can check if any children or vulnerable adult referrals have not been booked and alert the referring GP You can see a history of what is happening to a referral and at what stage it is at

Awaiting Booking & Acceptance Referrer action required Monitoring your e-RS Worklists – Login to https://nww.ebs.ncrs.nhs.uk – Select List from dropdown and click the load button Awaiting Booking & Acceptance Referrer action required Outstanding Referral Letters Advice & Guidance Responses

The Accenda update - Practice reports are now available for practices to run. Reports include :- Referral count per Specialty, including a count of referring clinician. Breakdown of the booking outcomes e.g. CAB – Booked, CAB – Deferred, CAB – Indirect etc. Specific information relating to referral return reasons and specific free type comments. Triage comments can be viewed Breakdown of referrals that have been re-graded by Triage e.g. Downgraded, Upgraded, Reassigned specialty etc. Comprehensive report of the entire data set RSS Survey - copies to complete in the break or take away with you. We need your feedback to help us move forward

Focus Group Members from GP practices , the RSS and the CCG will meet to discuss change and how it is implemented, new ideas, will feedback to colleagues and seek their feedback for consideration Ampleforth Brook Square Castle Health Hunmanby Scarborough Medical Group

Sharing Best Practice

The RSS Team will help you with any queries Call 0300 303 8676 Any other Questions The RSS Team will help you with any queries Call 0300 303 8676 Monday – Friday 9am to 5pm Or email: voyccg.rsservice@nhs.net