Cumbria Primary Care Electronic Referral and Pathway Management System

In May 2015 Castlerigg Consulting were appointed by NHS Cumbria Clinical Commissioning Group to provide project management services for the implementation of a Cumbria Primary Care Electronic Referral and Pathway Management System. 

Cumbria Clinical Commissioning Group had approved the development of the new Cumbria e-Referral Service (CeRS) for Primary Care with the aim of replacing current methods of referral by phone, fax, email or post with a single, standardised electronic process for all referrals from primary care.

After a comprehensive review of the market, NHS Cumbria CCG had procured Map of Medicine (MoM) Referrals to enable the CeRS. Castlerigg were initially tasked to baseline the current status of the work and review all documentation created, confirm outcomes and work with the Project Executive and stakeholders to define the scope of the project.  Whilst there were clear efficiencies in adopting a CeRS system from day one, it was essential for the new process to be faster and better than existing workflows and adaptable to practices’ current ways of working. We assessed the full future potential of CeRS to ensure the project delivered the transformation required.

The new service provided:

  • An easily maintained clinical decision making and referral process for primary care
  • Clear and comprehensive medical advice to the desktop, addressing issues of variability at source and limiting the need for additional triage services
  • The ability to re-direct pathway delivery where appropriate from the acute to primary care setting
  • The ability to deploy new pathways of care centrally, at pace and at scale
  • The ability to control acute referral pathways at scale 24/7, 365 days a year
  • The ability to provide a single function for the development, design and operational deployment of referral forms
  • The flexibility to accommodate variation within the health economy e.g. north vs south systems
  • Facilitated synchronous referral and receipting software integration
  • Plug primary care into the Cumbrian “Air Traffic Control System for Patients”
  • Real-time audit functionality to assess referral activity and performance at the practitioner, practice and locality levels

The project sat in the context of wider work to improve pathway management across the Cumbria health economy, with the CCG working closely with partners to re-define the healthcare model for Cumbria. The CeRS project was therefore a key enabler to a number of key clinical improvement initiatives in Cumbria.  Utilising CeRS will provide the capability for those redesigning healthcare to make sure that rather than 30-40% adherence to the new ways of working there is 90-95% compliance. 

We recognised the need to support primary care physicians to feel confident and comfortable with the new referral process to ensure a high rate of compliance with the new ways of working the software provided.  It was important that users saw real value in the new referral support advice provided, the ease of referral completion and the removal of the local burden of maintaining referral forms.

In addition to ensuring the implementation was delivered to a high standard and on schedule, the project had the following objectives:

  • To deploy pathway and referral functionality across primary care in Cumbria
  • To define, design and map 40 pathways and operationalise these into live operations
  • To define, design and embed the operational support and development arrangements for the CeRS
  • To decommission redundant referral practices
  • To improve GP satisfaction and confidence in referral management through the empowerment of clinicians to make informed clinical decisions. 
  • To provide ‘evidence’ to support General Practioners in their personal development plans (PDP’s)

Outcomes included:

  • Reduced variability of referrals across the 40 pathways implemented
  • Improved and consistent clinical care in pathway areas with potential to scale this to all relevant pathways in the next 12-18months
  • Consistent, clinical care closer to home by design
  • More efficient and effective referral processing and management established with improved administration of referral process (ability to version control) and standards established

Map of Medicine was implemented to primary care across Cumbria in early January 2016 with additional work ongoing to embed usage across all practices.  The current deployment is integrated with practice clinical systems and provides functionality to generate centrally managed referral forms.

Here's how…

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Project Management

The project was managed using PRINCE2 methodology. The pragmatic application of PRINCE2 tailored appropriately for the project allowed the team to proceed rapidly into delivery avoiding unnecessary ‘bureaucracy’ that can often accompany projects. Our tailored approach ensured that appropriate controls, reporting and governance were in place to ensure the project remained focused on the agreed objectives and outcomes.

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