Cutting waiting times using the NHS e-Referral (e-RS) advice and guidance channel

Northumbria Healthcare NHS Foundation Trust gastroenterology team, led by Consultant Gastroenterologist Dr Matt Warren, treats patients with a wide range of conditions relating to the liver, stomach and bowel across a mix of urban and rural settings.

The gastroenterology teams previously followed the traditional NHS Choose and Book model of the GP making a referral to the gastroenterology team and the patient then waiting a significant length of time for a face to face appointment in a consultant outpatient clinic. This first appointment would often then lead to further waiting for the patient who would have been referred for diagnostic tests, such as endoscopy, after the clinic. This would all add up to considerable length of time until patients would receive necessary and effective treatment.

Dr Warren and his team set out to change this. As part of their approach to get the best out of digital services, they made use of the NHS e-Referral Service (e-RS Advice and Guidance)  a two-way dialogue channel in e-RS which allows GPs and referrers to seek specialist input into a patient’s care. It allowed the team to share quick decisions on whether a potential patient could be initially seen online, in-person or whether advice could be given to a GP to manage the condition.

“At Northumbria, offering support to primary care to treat their patients without delay was pivotal. Our approach was very much to encourage GPs to ‘discuss with’ rather than ‘refer to’ us – enabling appropriate patients to be managed by their GPs, and reducing the waiting times for those patients who did need hospital appointments, and this builds up confidence in primary care that their patients with urgent gastroenterological problems could be seen within 1-2 weeks as a result”, explains Dr Warren.

“For me, it’s really important that we use all the technologies we have available, such as e-RS and electronic patient records, to get treatment advice as quickly as possible.”

“By using e-RS Advice and Guidance even more we felt we could offer any suitable management advice to a GP within 24 to 48 hours or if needed, look to see that patient ourselves.

“For a patient in the Scottish Borders we were also avoiding the need to travel 80 miles here and back for a potentially unnecessary hospital appointment in Tyneside.

“e-RS also allows our administrative centre to highlight pressure points on the service which we can respond to in a timely way. For example, if we had triaged face to face appointments in a hospital where there are no clinics coming up, we can ask patients to travel to another location, wait a little longer if they still want to be seen at their local hospital, or have a quicker online or phone consultation if appropriate."

“We try hard to make our responses beneficial to GP colleagues in terms of the management of similar situations they may encounter with other patients in the future. I think that the dialogue, even if it is online, between Primary and Secondary care colleagues can have huge benefits for the care of our patients and also give an understanding of where the pressures are on our services”.

Northumbria’s gastroenterology team is now seeing most elective new patients within two to four weeks of any referrals, and urgent patients within one to two weeks. Previously this had been closer to 12 to 14 weeks.

The percentage of patients being seen with the 18 weeks, Referrals to Treatment (RTT) timescales has risen, Appointment Slot Issues (ASIs) have been reduced and Advice and Guidance requests have risen compared to pre-COVID figures.

The team are also now rolling out some of their ways of working to other specialities in the trust, with early results looking positive.

Dr Warren is full of praise for his small team and of the support they received from GPs and other teams in the trust.

He said: “The effort and commitment of the team cannot be underestimated – we worked together with primary care colleagues to really make these positive changes happen for the benefit of patients.

“We’ve also been incredibly fortunate in Northumbria to have management colleagues who have a strong clinical focus and clinical background along with an in-house GP link - that's been a fantastic benefit.”

Find out more about the e-RS Advice and Guidance functionality and read more e-RS case studies.

If you would like to find out more about how e-RS is used in Northumbria contact [email protected].