Reduce referral-to-treatment wait times through triage and validation

Published: 24th November 2023
Hear from a Neurology and Dermatology consultant on how the National Consultant Network is helping NHS areas needing extra clinical capacity to reduce their waiting lists. It's a switch on/switch off service.
Rtt Webinar

Our clinically-led Referral Triage and Validation service supports hospital trusts needing additional temporary capacity for referrals. The service uses the clinical expertise of NHS consultants across 17 specialties from our National Consultant Network (NCN). The NCN consultants are brought in on a ‘remote locum’ basis, following local pathways and protocols, under the leadership of the local clinical leads, to triage and validate waiting list backlogs in bulk and/or new referrals as they come in. They can also be brought in to review and validate follow-up lists to ensure patients are seen/discharged in the most appropriate way.

When delivered by consultants, validation and triage ensures patients are on the correct pathway, urgencies are identified and management plans are written up where appropriate, for primary care to implement and keep the patient in the community. The level of support and guidance from the consultants means that the management plans are not dissimilar to a first outpatient appointment.

Specialty spotlight | triaging dermatology waiting lists

Dr Rabi Nambi, NHS Dermatology Consultant at the University Hospitals of Derby and Burton NHS Foundation Trust, is part of the NCN and triages dermatology referrals for hospitals needing the extra capacity.

During our recent webinar, Dr Nambi spoke about his experience. Listen to Dr Nambi discuss the referral triage process below:

The importance clinical briefing meetings with local teams

The meetings with the local specialty teams before conducting any triage and validation is paramount for a successful project. They can advise the NCN consultants on the local pathways and clinics available within the hospitals and community, as well as the local guidelines for specific patient conditions. Local teams who are initially concerned about out-of-area NHS specialists triaging local cases are reassured by the fact that all consultants are part of the specialist register and follow their specialty’s guidelines, e.g., the British Association of Dermatologists.

Listen to Dr Nambi discuss pre-referral and validation briefing meetings below:

Patients receive treatment plans ahead of appointments

‘One of the key benefits of the work is that I can advise on treatment options which can be implemented for an immediate impact on the patient’s disease management. Furthermore, the initial treatment for many of these patients actually turns out to be more definitive treatments, often removing the need for the patient to be seen in hospital at all.

‘Patient lives are made better and safer. There is a huge impact on the patient’s wellbeing and productivity, as well as their health.

‘The work also carries educational value and, along with the signposting of relevant online resources, has been appreciated by GPs.’

Dr Nambi gives patient examples in these short audio snippets which you can listen to below:

Specialty spotlight | triaging neurology waiting lists

Dr Jonathan Evans, NHS Neurology Consultant at Nottingham University Hospitals NHS Trust, also works as part of the NCN. He joined our webinar, alongside Dr Nambi, and shared insight into the benefits of the service for neurology referrals:

‘Neurology is very well-suited for remote triage because neurological disease is rare and symptoms are common and there are very clear pre-hospital pathways. Consultants are quite often directing Primary Care clinicians to these pathways and using existing guidance. The more these pathways are utilised, the more refined the referrals become, following best practice guidelines and exhausting all available avenues before a referral is sent.’

Improving referral quality 

Dr Evans also shared his experiences of working with local teams to validate their waiting lists. Understanding what cases are a priority for the local consultants and what local requirements are in place enables waiting lists to be efficiently triaged, getting patients the right care the first time.

Dr Evans also discussed the importance of regular meetings with the local teams to share examples of good referrals, those that could be improved and discuss any themes or patterns that have been noticed. It is also a chance for GPs to raise concerns if they aren’t able to see patients as quickly as needed, and any other obstacles and how all clinicians can work together to overcome them.

When rolling out a project in a new area, it is useful to understand area-specific nuances, such as local services available, organisation of a department, and medication offered. It can usually be in the form of a simple crib sheet, which can contain information from the local consultants on patient conditions they want to prioritise and those that are routine, which allows the NCN consultants to adjust their responses in accordance.

Hear more from Dr Evans below:

Benefits of Advice & Guidance prior to referral

Dr Evans explained that in several NHS areas, GPs are encouraged to contact specialists in the first instance for Advice & Guidance because the provision of initial management guides the GP in understanding if a referral is necessary. Advice & Guidance helps manage patient expectations whilst providing reassurance, so that if the patient’s presentation doesn’t warrant an onwards referral, they are supplied with a management plan for their care within the community. The contact between Primary and Secondary Care prior to referral allows rapid communication and is education for the GP.

‘In my experience, at least half of referrals can be managed with Advice & Guidance and often very successfully.’ – Dr Evans.

Listen to Dr Evans discuss the value of Advice & Guidance prior to referral below:

Impact on patient outcomes

Dr Evans concluded that on average, between a third and half of all neurology referrals do still need to be seen, but in many cases NCN consultants can re-triage and direct patients to more appropriate pathways, such as rehabilitation or elderly care medicine. Although this means referrals into Secondary Care aren’t always reduced, it does ensure that patients are on the most appropriate referral pathways.

Listen below to find out more:

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