How A&R is having a positive impact on our patients, primary and secondary care
Barts Health NHS Trust, in collaboration with NEL CCG and primary care stakeholders, have been piloting using the advice and guidance (A&G) portal on eRS as a single point of access for all advice and referrals in a new process known as advice & referral (A&R). To date the following specialties have gone live:
- Gastroenterology at The Royal London (RLH) in August 2021
- Rheumatology at RLH, Newham (NH) and Whipps Cross (WX) in November 2021
- Endocrinology at WX and NH in November 2021, Endocrinology at St Bartholomew’s (SBH) in December 2021
- General paediatrics WX, NH and RLH in December 2021
Early data is showing positive results with more than 90% of referrals being responded to within two days and almost 100% within five days across all of the pilot specialties. Conversion rates to appointments are variable across specialties.
For our gastroenterology pathway at RLH, which includes direct access endoscopy referrals, 80% are converted into an appointment. Since this system has been in place the waiting time for endoscopy has reduced by 14 days.
For rheumatology at RLH and NH, 60% are converted into appointments.
We have set up groups (known as clinical consortia) involving specialty consultants, primary care clinical leads and other interested GPs for gastroenterology, rheumatology, endocrine and general paediatrics, with more to follow. These groups will evaluate the A&R pathway and make recommendations. A number of common themes are emerging through the consortia, including the need for common clinical condition pathways, for example the endocrine group is working on a pathway for borderline high prolactin levels. The consortia are also developing FAQs and evaluating returned referral/advice requests to improve quality of referral and advice returns.
For information on which specialties have switched to A&R as a single point of access please refer to the Barts Health website.
We are working on a patient leaflet to inform patients of the change to the referral process and we are recruiting patients to our clinical consortia. We have already engaged the Barts Health patient groups and will be reaching out to practice participation groups, faith groups and Healthwatch over the coming weeks.
Next specialities due to switch to A&R
The following specialties are expected to join the A&R pilot in March 2022:
- Cardiac and thoracic surgery
- Elderly care
- Cardiac arrhythmia
- Memory at Newham Hospital
If you are interesting in joining a clinical consortium please contact Melanie Dalby. More detail on those specialties joining the pilot will be issued soon.
We would like to remind GPs that in order to make a referral using A&G you will need to click ‘advice’ on eRS. Before submitting the request the GP will need to give permission to the provider to allow for the request to be converted into a referral.
Once a service has switched to A&R the previous referral routes will close therefore the only way to access the service will be through A&G on eRS.
If you need any help, including guidance on what to do if an A&G request has not been answered, please refer to the A&G handbook.
A short ‘aide memoire’ is also attached with key reminders about the process for referring to A&R pathways.
A big ‘thank you’ to our partners across north east London for your support in making these changes to our advice and referral pathways. If you missed our GP webinar on this topic, which took place on Wednesday 15 December, you can do so here.