E-referrals in Wales pass one million

Deployment of e-referral and clinical messaging systems improves patient care and frees up GP time

More than one million electronic referrals have been sent by GPs for patients who need hospital appointments, passing the seven figure mark at the beginning of February.

The new system, which was made available to all GPs in Wales 18 months ago, replaces paper referral letters with a secure clinical message sent in an electronic format, streamlining the whole referral process.

Around 40,000 electronic referrals are now sent every month, with the one millionth referral being sent from Bryn Darland Surgery in Wrexham to Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board.

One million referrals is a significant milestone and demonstrates how technology can support better healthcare for patients

Dr Martin Murphy, clinical director at the NHS Wales Informatics Service, which led on delivery of the e-referral service, said: “One million referrals is a significant milestone and demonstrates how technology can support better healthcare for patients.

“Within the Betsi Cadwaladr Health Board almost 100% of GP referrals are now sent electronically and other health boards are working to achieve a similar uptake. Feedback from GPs is that this is saving an enormous amount of time and improving the process for patients.”

Paper-based referrals take time to produce and can involve the GP dictating a letter for a medical secretary to type up. This then has to be checked, printed and sent. The letter may not contain the full information and can get lost in transit.

E-referrals use a template, which is pre-populated with key information from the patient’s medical record held on their GP’s computer system, and includes vital information about medications.

Dr Murphy added: “As soon as the e-referral is sent it is with the hospital immediately, which is vital when referring patients with a serious or potentially-serious condition.”

Sian Richards, head of health records at Abertawe Bro Morgannwg University Health Board, said the introduction of electronic referrals had made the processes for receiving referrals quicker, safer and more transparent.

“The system offers a full audit trail so referrals cannot get lost between primary and secondary care. The process is now more efficient. It has resulted in a reduction in phone calls chasing information. It has also eliminated the need for primary care to resend referrals, reducing rework.”

The e-referral system uses the Welsh Clinical Communications Gateway (WCCG) and is based on a clinical messaging system developed by NHS Scotland and adapted for use in Wales.

There has been a clear improvement in the quality and consistency of GP referrals into the service, which has not only increased the efficiency in the allocation of cases, but has also removed the need to redirect referrals between service providers, which had previously caused delays when using paper

In North Wales e-referral has also helped to speed up where and when a patient can be seen, as the referral can be re-directed between the three North Wales booking centres, to ensure the patient is seen as quickly as possible at a location best suited to them.

E-referrals are also helping to reduce unnecessary hospital appointments and admissions as the GP can use the e-referral form to ask GP colleagues with specialist knowledge whether a hospital referral is most appropriate or whether another type of care could be provided through a GP-led service. GPs are also able to check on the progress of their referrals online to find out what is happening with their patient.

In addition, mental healthcare in North Wales is benefitting from the new service. Sean Clarke, primary care and psychological therapies programme manager at Betsi Cadwaladr University Health Board explained: “It has enabled mental health services to move to and operate a single point of access for adult mental health care services. There has been a clear improvement in the quality and consistency of GP referrals into the service, which has not only increased the efficiency in the allocation of cases, but has also removed the need to redirect referrals between service providers, which had previously caused delays when using paper. This system has genuinely improved patient care and I hope it is adopted elsewhere.”

The Welsh Clinical Communications Gateway is also being used to carry letters and discharges from hospitals back to the GP practice.

Dr Murphy said: “We are currently scaling this up and ensuring that this works seamlessly with the new replacement GP systems currently being installed in practices across Wales.”

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