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NHS Confer

On average, outpatient referrals across the country have risen by as much as 13% during 2008/2009, with many referrals made as the GP merely wants to seek advice.

 

Anecdotal evidence also suggests that up to 65% of patients attending outpatient specialty clinics are discharged with no significant pathology being detected and these referrals could be considerably reduced, for a proportion of patients, by timely access to specialist advice rather than by referral.

 

NHS Confer is a web-based application which facilitates clinical dialogue between GPs and Consultants in order to significantly reduce inappropriate outpatient referrals into secondary care; it supports the Planned Care - Closer to Home agenda.

 

Anticipated Benefits

There are significant benefits for GPs, patients, PCTs, Acute Trusts and the SHA as a whole which include:

• The ability for GP’s to access expert advice when they and their patients need it;
• A reduction in the number of unnecessary referrals into secondary care;
• Improving the patients’ experience, the right advice, the first time and in the right place – providing planned care closer to home;
• Better patient outcomes and improved observation and management of chronic diseases in primary care;
• Quicker treatment pathways for patients, treatment can commence in primary care weeks before an outpatient appointment would have been available;
• More appropriate use of specialist time and reduced interruptions to inpatient work from unscheduled calls and unnecessary referrals
• Improved quality of referral into secondary care where appropriate;
• Improved management of long-term conditions within Primary Care.

NHS East of England generated over 1.8 million GP referrals during 2008/09, resulting in over 1.5 million new patient attendances. This represents approximately 4,178 referrals per day.  Referrals into just 6 of those specialties: trauma & orthopaedics; cardiology, nephrology, gastroenterology, rheumatology and neurology represents approximately 20% of total referrals into all specialties and generated over 331,000 new attendances.

The cost of each of these referrals ranged from £135 - £385 per appointment. Reducing referrals by 20% across these 6 specialties alone could save the East of England over £10 million per year. Even based on a 5% reduction in referrals this still represents a significant cost saving of over £2.5million in the first year. No financial assessment of the other benefits has been modelled at this point.

 

Project Aims

The introduction of NHS Confer and the associated change management and analysis is designed to:

• Provide an efficient mechanism by which referrals can be avoided;
• Embed this through use of technology and change in practice;
• Quantitatively assess the benefits against robust baseline measures;
• Provide an evidence base and an understanding of the process for introducing NHS Confer more broadly in order to achieve a greater proportion of the potential savings.

The NHS Confer application

Working in close engagement with partners Cloud2, POSTcti is developing the software component of NHS Confer. The Pilot Solution, which will commence roll out in April, will offer:

• Consultant search, Profiles, Presence, Instant Messaging
• Ability to have an immediate Confer or schedule a Confer calendar appointment
• Desktop Sharing
• Buddy list, Star Rating, Confer feedback

 The technical solution is a custom web client to drive Microsoft OCS and Exchange Server. This is a state of the art technology using the very latest APIs for these technologies. The project has been made challenging by the need to deliver the rich functionality through a browser with no components being deployed to the desktop.

The majority of end users have a locked down PC environment and are running IE6 (though support for modern browsers is required). The application also needs to be hosted through a provider but accessible within the NHS N3 network. Furthermore there is a need to support breakout into a voice conferencing system, with the potential to support VOIP in future.

In addition to the software solution, POSTcti are also providing the infrastructure on which to deliver the service, from 4 carrier grade fully redundant data centres geographically dispersed across the UK ensuring a high availability service at all times.

 Implementation and change management

We consider the success of this project to hinge less on the technology than on the way it is rolled out in order to ensure user adoption, the change in process that it can engender and the ability to demonstrate that it is delivering real financial and clinical benefits. To this end the technical solution is being be supported by a suitable Tariff together with implementation, benefits analysis and review activities.

This activity is being drive by our partners CMA Associates.

NHS Confer will be rolled out in a pilot phase lasting from April 2010 to September 2010, across 3 Essex PCTs and their associated Acute trusts. A successful conclusion will lead to development of a regional implementation. There is also interest at a national level, with a future version expected to integrate with NHSmail.

Healthcare, NHS Confer, Presence and Availability, Collaborative Solutions, Improving Communications, Reducing Costs