1. 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 extra in 4 months
Possible £1.6 million over plan in outpatients by end of the year Includes follow ups, procedures etc

2. 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

3. 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%

4. 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

5. 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

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