We held our September Board meeting - read all the Board papers here - and here are some of the highlights from the meeting.
Referral management is a phrase that means different things to different people in different CCGs. In Wandsworth we’ve got our own distinct version and we've made real progress in managing the out-patient referrals process.
The NHS describes referral management as a way of monitoring, directing and controlling patient referrals with the aim of ensuring that the most clinically effective and cost effective outcomes are achieved, whilst at the same time respecting patients’ rights to choice (as defined in the NHS Constitution).
In Wandsworth, we have innovated referral management compared to many other areas because we use education and engagement to support GPs to manage referrals to hospital, instead of the more traditional route of using referral management centres. In other areas of England, Referral Management Centres have often worked well for a year or so but are not sustainable in the long term as they do not address the root causes of escalating or inappropriate referrals, nor they do place a focus on quality in the long term.
I’m really proud of what we’ve done in Wandsworth – here are just a few examples.
• Since January 2013, we have had 8.2% fewer referrals from GPs to out-patients.
• We have focused on engaging and educating GPs about conditions that are referred to clinics but that could have been managed just as well in the practice. We have had amazing feedback from GPs, who all say they have learnt something new about the referrals process.
• Kinesis is the system we use for GPs to communicate with hospital consultants before making a referral. It has enabled us to streamline hospital referrals, ensuring that patients are not referred if further investigations need to be done first, or where the GP can better manage the patient's condition. It has also improved the patient experience because it reduces the risk of a patient being referred to the wrong clinic or specialist. We expanded Kinesis last year and it has already led to 3000 requests for advice to consultants and helped us secure 300k in savings for use on patient care.
To further help GPs make referral decisions and to increase the quality of care for our patients, we are planning to roll out other support software integrated into the emis clinical system. We’ve completed the pilot stage and we’re now ready to introduce it across Wandsworth in the next few months.
None of these achievements happened overnight – it is the result of countless hours of work from GPs and the referral management team. When we started the programme we knew it may not lead to quick savings, but through more than a little bit of perseverance, we have managed to improve how referrals are handled and this then enables us to spend our budget more efficiently in the long run.
Next, the proverbial spotlight was turned on the Wandle area. Wandle is the largest of our three Wandsworth localities, and is made up of Balham, Tooting, Wandsworth Town, Southfields and Furzedown. Wandle locality, represented on the CCG board by Dr Michael Lane and Dr Seth Rankin, has 22 member practices, which serve a population of roughly 195,000 people – this means that just over half the patients in the borough live in Wandle. Wandle has its own character and diversity. More than half (55 per cent) of Wandle residents are aged between 20-44. In socio-economic terms, it has a diverse mix of people and several pockets of deprivation.
We introduced an investment budget for Wandle last year and we are working closely with the public health team at Wandsworth Council to get in touch with residents and ask them how about their health needs, paying particular attention to people who don’t tend to take part in public consultations.
One public health concern is obesity and particularly obesity in childern. We are proposing a scheme where children get weighed at school by the school nurse on a regular basis so that we can monitor if they are overweight or underweight. The children can also be referred to services such as MyTime, which works with children and families to promote a healthier lifestyle.
Wandle GPs are at the forefront of “social prescribing,” which means GPs can prescribe social schemes to help their patients and refer them to a social advice scheme run by Citizens Advice. Social prescribing enables GPs to take a more holistic approach to healthcare for these patients – what’s more, the evidence shows that social prescribing is working well in Wandle.
Marion Endicott chairs our Wandle patient group and the very active patient group is doing a stellar job of representing patients in the area. Like the area’s PPI group, Wandle’s community groups are ever-helpful with advice or support. It is precisely this kind of two-way dialogue that enables us to design and commission services that suit the needs of people in Wandle.
Finally, can I give a plug for our Annual General Meeting. It’s on Wednesday 24 September at our new offices. I really hope you are able to attend and learn more about our plans for improving NHS services in Wandsworth.