Secure web platform for advice and guidance to reduce inappropriate outpatient referrals

South West London Clinical Commissioning Group (CCG) boroughs, Merton and Wandsworth have 62 GP practices with over 640,000 registered patients. Primary care clinicians in both boroughs use a secure web based platform to obtain advice about management of their patients from secondary care specialists. 

Situation

Advice and guidance has been key to ensuring patients are managed appropriately, especially whilst some outpatient services have been scaled back during the ongoing COVID-19 pandemic.

Aspiration

To optimise GP referral decisions, to improve the patient pathway and experience and manage referral demand to providers. The aim is to provide virtual access to multiple specialities, including dermatology services where patients with dermatological or low risk skin conditions can be diagnosed and treated in the community, reducing the need for an outpatient appointment.

Solution and impact

Primary care clinicians across South West London CCG use Kinesis to obtain advice from dermatology specialists at St. George’s Hospital and Chelsea & Westminster Hospital. Secondary care specialists provide advice within two working days to support clinical colleagues to manage patients effectively in the primary care setting, recommending primary intervention or a referral as clinically required. This actively reduces inappropriate outpatient referrals and reduces waiting lists.

Functionality

The platform expedites clinical dialogue between referring clinicians and secondary care specialists to accelerate the management of patients in primary care, as well as ensuring patients are referred at the right time, with the required workup.

Capabilities

• Advice and guidance (A&G) to allow primary care clinicians to photograph patient conditions, upload images to the Kinesis A&G online portal as part of an advice and guidance request to a secondary care specialist
• Designed for easy adoption and use without disruption to current practice
• Advanced reporting functions for CCGs to extract the data they need on the number of advice requests by specialty, practice and trust; response times and the outcome of each request
• Addresses real-world clinician constraints to provide assured advice in clinically-relevant timescales
• Escalation via integrated SMS and email notifications
• Enhances learning and decision-making through connecting clinical expertise across sectors
  

Scope

• Enables primary care clinicians to make informed, rapid clinical decisions about appropriate care for their patient
• Provides primary care clinicians with direct access to secondary care specialties to reduce inappropriate outpatient referrals
• Bridges expertise across care sectors and specialties
• Reduces time to treatment and improve patient outcomes
  

Key figures/quotes 

Dermatology Kinesis combined activity for St. George’s and Chelsea & Westminster Hospital.

6 months pre-COVID-19 (Oct 2019-Mar 2020):

• 318 advice requests sent to secondary care specialists
• 82% of these responded within two working days
• 48% advice requests resulted in the patient being managed in primary care for longer without the need of an outpatient appointment

6 months during COVID-19 (Apr-Aug 2020):

• 843 advice requests sent to secondary care specialists
• 97% of these responded within 2 working days
• 46% advice requests resulted in the patient being managed in primary care for longer without the need of an outpatient appointment

The rapid response rates from secondary care has been invaluable in supporting primary care clinicians in providing efficient and quality care to their patients.

Find out more

Find out more on the Kinesis website

Key contact

Dr. Victoria Akhras, consultant dermatologist at St. George's Hospital NHS Foundation Trust and co-lead for the SWL Dermatology Network

victoria.akhras@nhs.net

Dr. Aditi Shah, clinical lead for planned care, SWL CCG and co-lead for the SWL Dermatology Network

aditi.shah@nhs.net