As the NHS prepares for the national policy of Advice & Refer and elective Single Points of Access (SPoA), much of the discussion centres on how to design pathways and plan capacities that ensure patients are seen in the right place.
Our Referral Triage and Validation service identifies which patients are suitable for community versus acute pathways, with data capture that exceeds traditional triage on eRS.
In a recent project across four NHS Trusts in the North of England, we triaged more than 20,000 referrals across five specialties. Consultants from the National Consultant Network (NCN) were brought in as ‘virtual locums’ under the guidance of local clinical leads, following local pathways and protocols.
As well as helping clear backlogs, triage outcomes highlighted where existing pathways were helping patients access the right care, and where there were opportunities for pathway re-design.
Whilst each Trust had its nuances, some consistent themes emerged when examining outcomes:
- Cardiology (Trust 1) – Almost half (46%) of referrals were diverted back to primary care. What these cases had in common was incomplete referral information; for example, ECGs were missing, or symptom details were insufficient. By identifying this pattern, the team was able to refine pathway criteria and consider GP pathway training.
- Gynaecology (Trust 1) – A significant proportion of referrals were clinically appropriate to be managed outside a hospital setting when supported with specialist input:
* 18% were returned to primary care with management advice
* 12% were suitable for a Tier 2 service
For these patients, that meant avoiding a hospital appointment and receiving care faster and in a setting closer to home.
- ENT (Trust 2) – 57% of referrals were deemed suitable for Tier 2 services, whilst 16% could be returned to primary care with comprehensive management plans. This meant that more than half of the ENT referrals could have benefited from community clinics or nurse-led pathways, enabling patients with conditions such as ear problems to be seen sooner and in more accessible settings. The data showed that where intermediate services were absent, patients were funnelled into traditional outpatient pathways – often with longer waits and more disruption.
- Dermatology (Trust 3) – The absence of clinical photographs significantly reduced the quality of triage decisions. 12% of referrals were returned to primary care, and 8% were suitable for Tier 2 services. For patients, incomplete referrals could lead to requests later returned with additional information or delayed reassurance. The NCN consultants identified that clearer referral guidance, including image acquisition, and expanded community services, e.g., benign skin condition clinics, could support better, quicker patient care.*
* 23% of referrals were moved to urgent suspected cancer (USC) pathways, highlighting critical upgrades and downgrades.
Across these specialties, the triage work highlighted how Trusts could maximise efficiency and utilise specialist resources.
Key insights included:
- Where referrals were returned or redirected, many patients received comprehensive management plans, helping them avoid unnecessary hospital attendances.
- Routine outpatient acceptance rates helped the Trusts understand where demand was appropriate and where alternative pathways could safely support patients.
- Tier 2 suitability showed where investment in community-based services could reduce waits and improve patient experience.
- Referral content quality directly affected how quickly consultants could make safe decisions and offered opportunities for GP education.
If you’d like to find out how we can support your NHS area with elective waiting lists, please get in touch with us on hello@consultantconnect.org.uk or call 01865 951207.
