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Human Touch

Human Touch
8 December 2014

In Wiltshire, particular emphasis is being placed on putting the personal approach back into the referral process, with very pleasing results.

In Wiltshire, particular emphasis is being placed on putting the personal approach back into the referral process, with very pleasing results.

The journey started four years ago, when Wiltshire Primary Care Trust (PCT) took the decision to implement a referral support service which would benefit Wiltshire’s patients just as much as the county’s 56 GP practices. Taking full advantage of their core knowledge of all local providers’ contracts and policies, the PCT took the initiative to create an efficient and high quality service, delivered with a personalised approach for every patient. With the aid of choose and book, combined with a deep local and regional understanding gained over the previous four years, the Wiltshire referral support service (RSS) has developed and streamlined the referral process to create and maintain an authentically patient friendly system. The benefits are quantifiable and the whole process has proved more time and cost-effective than a general referral process would be expected to deliver.
Thirty-five Wiltshire practices, covering 337,828 patients, currently use the RSS, and continual requests for its support means that number is ever-increasing. The Wiltshire approach has been to simplify what was a previously confusing electronic system and then introduce the human touch for every patient during the appointment-booking stage. This means that once a referral has been accepted into our service, we take responsibility for any rejections, cancellations or re-scheduling ourselves rather than allowing ‘the system’ to make automatic re-arrangements. So when a patient contacts us with their unique booking reference number (UBRN) we are able to have a personal conversation with the patient, striking up a relationship so that we can properly identify their needs.  Sometimes this might be something as simple as helping them to work out which bus they need to catch in order to get to their appointment – but whatever it is, we make sure that every piece of their referral jigsaw is organised clearly and easily, providing reassurance to the patient, meeting their expectations and ensuring that their experience of the outpatient process is as straight forward as possible.  
 As we know, the outpatient appointment system is subject to many different influences and concerns, all of which have the potential to confuse or delay not only the patient, but also the GP and the process itself, particularly when conducted within the patient’s allotted GP appointment time. Here are some basic, familiar examples of the sort of requests a GP would hear:
  • Can I please book an appointment with a female consultant?
  • Can I claim travel expenses for my appointment?
  • I would like to book the earliest appointment possible please.
Wiltshire’s RSS employs experienced clinicians, all with medical backgrounds, who triage the individual patients when they telephone the service for their referral. This means that our GPs are able to focus on their patients’ health needs for the entire ten minutes of their allotted appointment time. Keeping up-to-date with medical knowledge, referral pathways, policies and contracts is of crucial importance for all our RSS staff and is central to our ethos if the service is to maintain a smooth, efficient and responsible service. Triaging has many beneficial aspects, including:
  • A completed referral with attached medical history, with general ophthalmic support (GOS) form 18 if necessary.
  • Correct patient information – their address and contact numbers.
  • An indication of whether the patient could be more appropriately treated in a primary care setting (or at home) via community services.
  • An indication of whether the patient could be more appropriately treated by a GP with special interests, in a more local setting.
  • Referring the patient for a locally available test, for example an echocardiogram, 24 hour tape.
An understanding of whether the patient meets one or more of the exclusion criteria set out by private hospitals with NHS contracts, before an appointment is made.
Endeavouring to ensure the patient is given an appointment in the correct speciality clinic at the first appointment.
Advising the GP practice about the necessary, correct form for completion when a suggested referral procedure requires funding.
Encouraging and promoting best practice by helping GP practices to comply with agreed commissioning pathways, checking the referrals and managing referral thresholds across the group. We are able to provide feedback where referrals do not meet minimum requirements.
Obviously the most important aspect of our service is to offer patient choice.  We are a point of contact for not only the GP practices and patients but also for our commissioning colleagues within the clinical commissioning group (CCG). Every time a new pathway is created or a service is changed, we are the first point of contact, ensuring consistency across the system. Another benefit is that we have been able to build up a data set which allows for thorough monthly reporting and the gathering of a bank of evidence which is easily accessible to GPs and the CCG.
The benefit of access to real time referral information cannot be underestimated for our commissioners. This data is not easily obtained across all practices when they refer into multiple providers, and the choose and book system has limited reporting functionality. Referrals into secondary care account for a huge amount of activity, so it’s essential that commissioners are able to review and analyse data at the point of referral, rather than relying on providers for the information.
Supporting practices in their compliance to agreed pathways ensures financial as well as quality benefits.  
It would be misleading to compare the Wiltshire RSS with a referral management centre. We provide a completely different type of service and approach that is holistic, compassionate and focused on meeting our patients’ expectations at every step of their pathway.  
Patients are given a full choice of providers within a radius of 40 to 50 miles from their home address, taking into account the individual patient’s suitability for each provider.
The introduction of private providers with NHS contracts has also proved to be a challenge. Our patients are, on the whole, keenly aware of these providers but do not realise that the provider may not be able to treat their specific condition. A patient who books through choose and book or directly via the private provider’s website could face going back to their GP, disappointed with ‘the system,’ having been rejected as unsuitable for treatment, and find themselves back to the start of the process again. Wiltshire’s RSS allows us to have the conversation with the patient straight away, identifying and discussing with them the appropriate providers and booking their appointment there and then.  As a result, we have only a 0.05% rejection rate from our private providers. This means that our GP practices are saved from the burden of complaints and queries from  disillusioned patients, freeing up more of  their time to concentrate on consultations and core practice business.
We are also in a particularly strong position to utilise the components of the NHS Constitution and the 18 week referral-to-treatment pathway when it is necessary to challenge our providers on their contractual requirements.  
Our hard work has ensured a balance between modern technology, good communication and compassionate patient care. We’re proud that our successes have been recognised – so far, six CCGs are interested in emulating the Wiltshire RSS method. Their approaches will be equally successful if they ensure that, like Wiltshire, they stick to an embedded ethos that the process exists for the benefit of the individual patient. It is their appointment in a clinic which is correct for their treatment.  They are seeing the clinician of their choice in an environment which meets the patient’s particular circumstances. We do not complete second referrals when it is not necessary.
What’s more, our patients, our practices and our providers applaud and continue to praise our service. We think that’s what good care looks like in today’s NHS. 

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