High Impact Intervention

There is a lot of good innovative practice across the NHS which isn’t always taken up across the sector. Our High Impact Interventions work is aimed at identifying good, evidence based practice and collating it into simple service specifications. This will allow all CCGs to transform their services where there are opportunities to ensure that patients see the right person in the right place, first time.

Consultant to Consultant Referrals

Demand for elective care services is continuing to grow.  Since 2005/6 total outpatient appointments have nearly doubled from 60.6m to 118.6m. 501,000 patients were waiting longer than the 18 week standard for hospital treatment in June 2018 compared to 373,000 in June 2017 – a 26% increase to the previous year. The steady rise in referrals has contributed to that increase.

The Elective Care Transformation Programme has developed the Consultant to Consultant Referrals (C2C) good practice guide with support from an expert clinical working group, with membership including the Royal College of Physicians, and NHS Improvement. The guide has been developed to support health economies to manage the increasing number of consultant to consultant referrals in elective care.  This is achievable through transformation of outpatient services through effective use of available resources and development of new ways of working, leading to improvements in patient pathways and patient experience.

The good practice guide has now been published. It provides an overview of good practice for C2C referrals. It includes guidance on C2C policies, examples where C2C referrals are beneficial, and transformation of service delivery through the use of case studies.

Musculoskeletal Triage

Musculoskeletal (MSK) conditions affect approximately 9.6 million adults in the UK.

MSK clinical triage services provide specialist clinical review of GP referrals for MSK conditions. They can involve a review of the referral or a face-to-face appointment with the patient in a community setting. This review by an MSK specialist ensures that patients are seen in the most appropriate setting across the primary, secondary and voluntary sectors.

MSK triage services can also reduce demand for secondary care services which often face large annual increases in referrals. Triage schemes can reduce referrals by 20-30%. That is equivalent to a reduction of 2-3% in all GP referrals.

This means that those patients who need to be seen by a hospital consultant are seen as quickly as possible.

Additionally, the NHS England RightCare programme has identified that 31% of all elective care appointments involve musculoskeletal pathways.

Clinical Peer Review

Clinical peer review (CPR) involves GPs reviewing each other’s new referrals to provide constructive feedback to the referring GP. This ensures that all options are explored and that patients get access to the optimum care which means they see the right person in the right place, first time.

Published evidence suggests CPR can create sustainable changes in referrals behaviour through knowledge sharing. It can also:

  • reduce the overall number of referrals to outpatient services
  • increase the likelihood of GPs referring when necessary
  • improve the quality of referral letters
  • increase the likelihood of GPs referring patients to the most appropriate care setting, first time.