5 minutes…. with our Referral Backlog Triage Lead

Published: 2nd July 2021
In this article, we catch up with our Referral Triage Lead, Kat James, who has been working with NHS areas to help accelerate their recovery work over the past few months.

In this article, we catch up with our Referral Triage Lead, Kat James, who has been working with NHS areas to help accelerate their recovery work over the past few months.

What initiatives are you working on to help reduce backlogs?

“What we’ve seen is that all areas are focused on bringing their elective activities back to pre-COVID levels. The main challenge is staffing.


Our referral triage service has been welcomed as a temporary support. The ‘virtual locum’ NHS consultants from our National Network work with the local teams picking up triage work as and when needed – literally on a switch on/switch off basis.

We’ve worked on 2 main models over the last few months:

  1. The ‘virtual locum’ NHS consultant works through the entire backlog in a specialty to prioritise which referrals need to be seen first.
  2. The ‘virtual locum’ NHS consultant provides a front-door triage service for new referrals as they come in.”

What impact does this work have on waiting lists?

“Referrals are prioritised according to urgency. As part of the work, the ‘Virtual locum’ NHS consultant will identify referrals that might need to be seen in a different service within the hospital or a community setting.

Specialty dependant, our data has shown that between 20-30 % of referrals are returned to primary care with detailed accompanying advice. This assists the GP in managing or treating the patient in primary care where it is safe and appropriate to do so. For example, our “front-door” triage service in Northampton shows that 26% of referrals in cardiology do not need to be seen in hospital.”

Can the service support with diagnostics?

“For all referrals the ’virtual locum’ NHS consultant will advise on the correct diagnostics to be initiated – whether the referral is accepted to be seen in hospital or returned to primary care. There is nothing worse than for a patient attending a first outpatient appointment after many months of waiting to then be told to join another waiting list to have their diagnostics done.”

You said that the “virtual locum” works as part of a local team. How does that work in practice?

“This service works so well because it is based on NHS consultants working with NHS consultants. Once we’ve allocated the ‘virtual locum’ NHS consultants doing the triage, we set up a briefing meeting between them and the local clinical lead for the respective specialty. It’s important to discuss what’s available in that area, for example in terms of diagnostics in the community, rapid access clinics etc. If certain services are unavailable, the ‘virtual locum’ NHS consultant will be able to advise on the best alternatives and treatments in the interim. A sample from the first few referrals in a new project will have a second review from the local team to ensure everything is being reviewed according to the trust’s preferences.”

Many local teams already run a RAS service. How does the Referral triage service add value?

“We bring in external ‘virtual locum’ NHS consultant capacity to support exactly that, but remotely, meaning that the internal capacity can be focused on running clinics.”

For new projects, how long does it take for the work to commence?

“Once we’ve been given access to the respective backlog list and the clinical briefing has taken place, we can usually start the work 2-3 days later.”

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