Swindon GPs Optimise pathways

An Optimise screen

A new referral management system created by GPs and hospital clinicians will be launched in Swindon next month.

One hundred referral pathways are in the online Optimise system, which uses check boxes to make sure GPs have tried other reasonable treatments before referring on to secondary care.

The pathways have been developed by GPs and reviewed by hospital consultants.

Dr Peter Crouch is chairman of the Swindon Clinical Commissioning Group - covering 220,000 patients - and director of clinical commissioning for the local primary care trust.

He said the Optimise project was created to deal with a year on year increase in referral activity.

However, the aim of the new system is to bring all GPs within a normal range of referring, rather than to decrease referral numbers.

GPs have agreed a checklist of things they should ask a patient, and other treatments that should be tried, before making a referral. The more boxes that are ticked, the more likely the system is to accept a referral.

Icons alongside the check list give GPs access to external guidance, such as the Oxford Knee Score, which advises on the threshold for knee replacement.  

Once a GP completes the pathway, the referral is sent to a referral management centre run by NHS Swindon to handle discussion with the patient. The centre already handles about 10,000 referrals a year.

Dr Crouch said he had a golden rule that each pathway should take no longer than 75 seconds to complete - or GPs would not use it.

He said this had meant that in some cases consultants had to significantly pare down the list of questions GPs should ask their patients prior to referral.

However, he said that some had conceded that many of the questions were actually of “no use at all” once they were examined closely.

“Just designing the pathway has got them [GPs and consultants] to discuss what should or should not be done,” Dr Crouch added.

The software can always be over-ridden by GPs, so it does not take away their ability to refer if they really want to.

Dr Crouch also said the pilot software had been extensively tested to make sure patients did not “fall though any cracks in the system.”

A number of neighbouring PCTs have shown an interest in buying Optimise, and NHS Bournemouth and Poole has already signed up.

Dr Crouch said the system was being offered to other trusts for just £17,500 on condition that any new pathways created by GPs would be available to all users. The system goes live in Swindon on 13 April.