Reducing waiting lists efficiently

We recently completed over 14,000 referrals across several NHS Trusts.

Where applicable, cardiology referrals were sent straight to test, with the results reviewed again by the consultant before deciding if an appointment was needed or if the referrals could be returned to primary care with a management plan:

• 41% of referrals were safely removed from the waiting list and either returned to primary care with a comprehensive management plan, or redirected to a community provision or other more-appropriate service.
• 12% were identified as requiring an upgrade to ‘urgent priority’ and were prioritised for a face-to-face appointment.
• The remaining 47% of referrals were accepted and booked in with the relevant clinicians for an outpatient appointment (e.g., at the nurse-led clinic or with a consultant).

‘In my experience, 25-30% of cardiology patients on waiting lists can be appropriately managed within primary care with detailed advice. These patients don’t necessarily need a diagnostic test but would benefit from a management plan and reassurance. Another portion of patients would benefit from a simple diagnostic test often available within primary care, such as an ambulatory ECG, echocardiogram or 24-hour blood pressure monitor, so we can request those tests and then rapidly review the results when they are returned.’

– Dr Stephen Cookson, NHS consultant triaging referrals through the service.

Over 4,000 routine dermatology referrals were recently triaged across one NHS Trust, including validating the waiting list by communicating with patients to obtain updated images, checking whether their condition had changed or whether they still needed to be seen, and identifying instances where they may have been treated elsewhere. This resulted in:

• 68% of referrals safely diverted from the waiting list and returned to primary care with comprehensive management plans.
• For the remaining 32% of referrals, the triage work ensured patients were on the correct pathway, with clinical risks being assessed, including 5% of referrals prioritised and upgraded to an urgent or USC appointment.

‘Re-triaging patients prior to consultation is really important. It ensures that care is both timely and appropriate, allowing us to prioritise those with the greatest need while reducing unnecessary appointments.’

– Dr Zainab Jiyad, NHS Consultant Dermatologist on the NCN.

We recently completed over 12,000 referrals across several NHS Trusts:

• 48% of referrals safely diverted from the waiting list, 24% of which were returned to primary care with comprehensive management plans, 23% redirected to another service and 1% booked into diagnostics.
• The remaining 52% of referrals were directed to the right place, first time, with:
  • 47% booked into a routine outpatient appointment (34% without additional diagnostics needed, 13% with diagnostics needed)
  • 5% accepted for an urgent appointment

‘Directing referrals to the appropriate clinic, upgrading or downgrading referrals and offering advice and guidance ensures that the patient is in the right place the first time. It makes best use of finite resources, maximises treatment in primary care and avoids waste.’

– Dr Andrew Coatestworth, E.N.T Consultant triaging referrals through the service.

Over 12,000 referrals were recently reviewed across several NHS Trusts, resulting in:

• 31% of referrals safely removed from the waiting list, including 25% returned to primary care with comprehensive management plans and 6% redirected to a community or other service.
• 64% booked for a routine appointment without diagnostics.
• 3% upgraded to a red flag pathway.
• 2% upgraded to an urgent pathway.

‘As an ICB, we have worked closely with Consultant Connect and our provider organisations for referral triage and validation. Consultant Connect is a responsive and professional organisation. They have gone out of their way to provide timely support and services to set up this project. They have always been flexible to our needs, working around our systems and processes to help deliver our projects. Their team of staff are friendly and knowledgeable and always engage to provide the best service possible. They deliver a service in the background that has assisted us to improve the delivery of our services and ultimately more timely care to our patients.’

– Helen West, System Lead for Elective Recovery, Coventry and Warwickshire ICB.

Over 16,000 referrals were recently reviewed across several NHS Trusts, resulting in:

• Up to 43% of referrals safely diverted from the waiting list (e.g., returned to primary care with a management plan or redirected to a more suitable service).
• Up to 57% of referrals were directed to the right place, first time (e.g., upgraded to USC, accepted as a routine appointment either with/without diagnostics prior to the appointment, etc).