Self-referral could untangle the red tape wrapping up patient waiting lists

Up to 30 per cent of patients seeking a GP appointment each year do so with a musculoskeletal complaint, such as back or neck pain. Here, Chief Technology Officer Dheeraj Rathee explains why, with the NHS under enormous pressure, new models of care need to be built and implemented around the needs of patients – and they don’t just work for physiotherapy. 

Around 100 million appointments in England alone are dedicated to a musculoskeletal complaint – all of which could be freed up if patients were given the choice of a physiotherapist as their first point of contact.

This was the thinking behind the Provide Digital Smart Referral System which was launched to allow people to self-refer for physiotherapy services without having to see their GP, saving themselves and
the medical profession precious time and resources.

The system was requested by – and developed with – clinicians at Essex-based parent company Provide CIC and came about thanks to a Knowledge Transfer Partnership, which are designed to help businesses innovate for growth.

There was a specific operational and clinical need based on data that revealed it was taking upwards of three months for a patient to access treatment, mainly because, although a GP referral form went straight to central processing unit, it contained minimal information.

There were also various forms being used to refer patients from a variety of sources, from different hospital departments and GP surgeries.

This lack of consistency often created a backwards and forwards between the central processing unit and the person referring to get the information needed surrounding the injury, and then to determine the urgency of the triage.

Because the waiting list was so long, some patients had often self-healed before the appointment, but were still taking up a place in the system.

Clinicians also found the referral forms didn’t always capture the details of how the problem or injury started, so had to spend large portions of the initial appointment piecing together background information from the patient, months after the fact.

The results

Since its implementation in October 2021, the system has processed 5,500 referrals, and the results of this new, streamlined process have been astounding.

The system allows for management of 1,100% more patients than were being processed previously.

And, what’s more, the number of GP appointments for physiotherapy services has been cut by at least half, leaving doctors more time to focus on patients who need to see them.

Patient feedback shows people are happy with the quicker service, while admin time has been slashed. In fact, where it used to take two to three hours of backwards and forwards to ensure each form had the full information on, it now takes on average five minutes to process each form – a time saving of 3,500%.

A digital platform, it features a questionnaire, developed with clinicians, which allows patients to input all the relevant information in one place. This is then digitally categorised and prioritised, with urgent cases flagged.

Meanwhile, if the patient is not deemed to need urgent care, they are directed to other features on the app that teaches them how to manage and treat their condition at home.

In 2012, when self-referral was first adopted as a quality, innovation, productivity and prevention approved pathway, health economist modelling showed it cut costs by £33 per patient, which equates to a saving of up to a quarter.

But the critical point with self-referral is the vast improvement it offers for patient care.

For starters, self-referral helps prevent acute problems from becoming chronic and reduces long term pain and disability.

So does it only work for physiotherapy?

The answer is no.

The Smart Referral System has been such as a success for Essex-based Provide Wellbeing, that it has already rolled out the project into two more of its services – carpal tunnel syndrome and vasectomies.

For carpal tunnel issues, the Smart Referral System is used to triage patients who are seeking a diagnosis and an initial assessment appointment, identifying those who need treatment options such as splinting or injections for less severe cases, and those who need more urgent treatment such as an operation.

Similarly, the system was adapted for vasectomy services, as a way for people to self-refer and to help staff manage the waiting list.

The use of this system for vasectomy services allowed the processing of referrals to continue despite pandemic restrictions.

This meant that at a time when patients had less access to face-to-face appointments with their GP, they were still able to begin the process for a vasectomy.

The team at Provide Digital is excited at the prospect of the technology being rolled out further, thanks to the recent restructuring in the NHS, which sees Integrated Care Boards being established to create a more joined-up local approach.

As the architecture of the software is so versatile, it can be upscaled for almost any NHS service across the local ICB area, and beyond.

Furthermore, there is scope for integrating this technology to improve other aspects of care pathways.

An example of this is improving and streamlining data kept on patient records, which would further automate the system, and free up time and resources by capturing more information on a patient’s file.

Are there any negatives?

One argument we encounter is that self-referral could lead to an overwhelming increase in referrals.

However, research shows that if sufficient resources are in place this should not be the case.

In fact, self-referrers are shown to need fewer appointments, because problems are caught earlier.

A less common concern, but still raised occasionally, is that of safety.

But even here, clinicians complete extensive training to identify red flags and will refer any patients they have concerns over to a medical specialist.

Besides which, self-referral it has been the primary route into private treatment for decades.

In short, when GPs are under such enormous pressure, patients are waiting longer for an appointment and budgets are becoming ever tighter, self-referral can provide a lifeline, saving valuable time and money and ultimately, enhancing patient care.

If you would like to know how the Self-Referral System could be adapted to suit your problems, contact us today.


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