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Referral Management for Minor Oral SurgeryIain A Pretty
Professor of Public Health DentistryUniversity of Manchester
A celebration of those ‘ light bulb moments ’ that are transforming patient experience and care across the North West
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Overview
• What is the issue?• How did it come about• How did we address it?• Why undertake research?• The NIHR programme• Challenges
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Statement of Disclosure
I have a financial interest in referral management systems.
I am working with the current pilot in NHS Greater Manchester as one of a number of Consultants
delivering the service under a SLA.
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What’s the issue?• Minor oral surgery referrals increased year on
year since 2006• Other dental referrals into secondary care
followed same pattern• Significant issues for
– PCTs– Acute trusts
• Cost profile between primary and secondary care (£150 vs £650 – £1200)
• Need for a single operating framework
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How did it come about?• 2006 saw the introduction of a new dental
contract• Same payment for referral as for undertaking the
procedure (NHS Band II – 3 UDAs at £25 per UDA)
• Acute trusts welcomed additional activity• Investment into staff grade positions• 18 week issues began to emerge• Performance issues in the primary care
contracts• No simple intelligence on referral patterns
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What did we do?• Started in NHS Manchester• Pilot work• Central capture system developed• Initially with basic IT systems (lack of N3)• Developed into a rolling programme• N3 connectivity developed• Enhanced the NHS NET provision• Currently in 7 out of 10 GM PCTS• All PCTs by year end
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How does it work?
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The ProcessCentral Capture• Referrals received by post, email (NHS NET),
fax or direct entry to website• Each has a URN
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The ProcessAdmin Triage• Each referral is assessed for completeness• Rejected if areas not completed• Then automatically sent to:Consultant Triage• Assesses for case complexity• Assigns to appropriate service• Provides clinical advice and supportSent to Provider / Referrer• System automatically sends via NHS NET
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The RMS IT• Hosted on CfH approved servers• Web based – access using 2FA• All referral details stored securely• Sent from NHS NET onwards• Governance enables referrals to be reviewed,
reports issued and issues tracked
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Impact 1• Significant improvement in the quality of referrals
within 2 months of implementation• Reduction of “inappropriate referrals” seen within 3
months • 58% of cases of minor oral surgery identified as
suitable for primary care in first 3 months• 33% of cases identified as such from month 4• Savings achieved on MOS referrals• Clinical quality and advice on peads & restorative
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Impact 2• Cost savings• £250,000 saving per month in GM using system
based on MOS on average• Service costs circa £35,000 per month for GM
currently• Not taking advantage of all possible savings as not
all PCTs have primary care services• Quality and governance of system enhanced• Provides rich health needs assessment data
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Risks• Promotes referrals by stimulating demand• De-stabilises acute trust departments• Risk to training and learning • Case complexity issues may not be adequately
recognised by tariff• Leakage practices• Industrialisation• Quality of care
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Research• Anecdotal evidence suggests the system is
great!• Lets roll out across England!• NHSCB a great opportunity to do this with new
care pathways and secondary care commissioning
• The NHS way of implementation
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Research• Anecdotal evidence suggests the system is
great!• Lets roll out across England!• NHSCB a great opportunity to do this with new
care pathways and secondary care commissioning
• The NHS way of implementation
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NIHR SDO / HSD&R• Research bid to SDO workstream• Described a robust research approach to
evaluating the referral management system• Applicable to all schemes with primary care
diversions• Aims to assess impact across the whole system,
and for all stakeholders• Take a virgin site (in terms of MOS and referral
management) and undertake staged implementation
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RefTon Project• Based in NHS Sefton with electronic only
submission• Will assess impact on
– Practices– Patients (in terms of quality)– Acute trusts– Commissioners
• Will consider– Cost– Quality– Whole service impact
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Conclusions• Intelligent, clinically led referral management
can drive quality care• There are cost savings to be made• Not without risk or consequence and
engagement is key • RMS likely to be a key recommendation of the
NHSBC• CCGs are developing RMS – need to ensure
approach is evidence based• Kernow CCG is excellent example
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ThanksNHS• Colette Bridgman• Ben Squires• Lesley Gough• Gina Lawrence• Anne Lamb
University of Manchester• Martin Tickle• Caroline Sanders• Stephen Birch• Tanya Walsh• Joanna Goldthorpe
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Q&A