How could technology improve your lives at the point of care? What would you like to have?
CS Continuity of the initial referral, to be able to monitor patient’s full journey, including the non-GP initiated referrals. I think there needs to be more openness and transparency in the technology so that we can see where that journey is taking our patients. And it is better for the patient because, of course, when the patient contacts their GP he may now know at that
time that actually the patient has now been referred.
JS The King’s Fund report talked about e lost our relationship with the secondary care consultants. We have trialled in our area obtaining email advice for those with diabetes – that is a use of technology where perhaps people do not need a referral at all. You just need somebody to look at the patient’s data and give you sensible advice based on that.
PP The technology I would like to see would be GP/Consultant Skype consultations for advice and guidance.
GD The GP computer record. Just imagine, you know, you have seen someone who had come along with change in bowel habit so you are going to refer them. You click a refer button then automatically everything will just swish across onto this form that could be sent instantly. I think that, while we do not want to be dumbed down in primary care, you have made a decision to refer that is not being challenged. What is being challenged is the quality of the data.
JJ What I would like to see is a single patient held health and social care record. We treat patients much too passively. Patients have to more responsibility for their own health and care. The other thing is I think we need a hearts and mind cultural change amongst doctors as to how they use technology. It is great there are all little bits of innovation going on, but like the initial computerisation of the NHS there are still dozens of systems that do not speak to each other.
Mo Ali I think we are all looking in the wrong place for the technology. The patients already have the technology. They have it on their phones. Trying to build a system is the wrong way to do it because everything is already ahead of us. I think we need to catch up with it, not trying to build it. Why am I acting as a gatekeeper for something that they are quite intelligent to do? We need to put more information out there so patients can follow it through.
GD What we need is a patient navigation map, so that they can navigate themselves.
PP It does not matter what technology we actually bring in, it is changing the behaviours of the GPs in referrals. If you do not actually get that right, no amount of technology is going to help us.
It is clear that true integrated care, and keeping the focus on what is best for the patient, is crucial if CCGs are to succeed with highly-effective referral management strategies.
At Map of Medicine, the CCGs we work with to transform primary care tell us that evidence-based, locally relevant care pathways sit at the heart of improving the quality of patient care.
Our experience over the past 18 months in rolling out point of care referral management solutions has taught us that:
– Speedy access to high-quality referral letters make a difference. When referral letters are embedded within clinical systems and automatically capture patient information it can significantly reduce the administrative burden on the GP.
– Smart referral software alone is not the answer. Those CCGs who work with us to train and support GPs, Practice Managers, Consultants and the wider health community on local care pathways see a far better level of engagement leading to improved outcomes.
– Transparency on referral activity is vital if commissioners are to make informed decisions about service design. Map of Medicine, for example provides real-time analytics on the volume of referrals being made by GPs, associated costs, care pathway usage – both across the CCG and at the individual GP level.
Cultural change is happening. Commissioners are innovating and commissioning for whole patient pathways. Clinicians are embracing technologies and new ways of working that can support their practice; patients’ increasing involvement in their care using their own technology devices is also adding momentum to the referral revolution.
The results of The Commissioning Review’s survey further compound the need to continually support our GPs. It revealed that nearly 40% of GPs asked did not have access to locally agreed care pathways, or were not aware of them.
The result – the administrative and clinical functions to make a referral can become detached, sometimes making a GP’s work unproductive and increasing the chance of administrative mistakes and patients being bounced around from provider to provider. This is undoubtedly frustrating for the GP and the patient. For behaviours to change, we must break down the barriers for GPs to make decisions in line with the evidence and local protocols – let’s make it easy for them.
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