Abstract
Project Synopsis: Planned care reform across the Health Board with a specific focus on the surgical board. Engagement and strengthened integrated working to ensure primary care and patients have improve accesses to secondary care services based on best practice localised guidance. Utilising a series of tools we have ensured the most in need are seen in a timely manner whilst enabling primary care providers (PCPs) to support patients who currently do not require specialist treatment with community-based care. An ongoing evaluation, reporting and improvement model ensures the best practice advice is continually improved to ensure optimum patient outcome and efficiency.
Plan: We provided PCPs with localised agreed best practice guidance on the assessment, management and referral criteria for patients with common clinical conditions, written in a collaborative way between primary and secondary care, visible at a single location. We used HealthPathways, a clinical information portal, where PCPs can access all the clinical pathways in a single location.
We employed and embedded GPs within secondary care departments to provide a community perspective and ensure referral appropriateness by triaging referrals against the advice provided, ensuring supportive feedback and guidance if referrals were inappropriate.
Outcome: Over 450 clinical HealthPathways have been created covering medical, surgical and allied health departments in Cardiff. Website view are growing month on month with over 20,000 views per month.
9 interface GPs in post across the Health Board working within departments providing a primary care perspective, creating clinical working groups, writing additional HealthPathways and triaging referrals against the HealthPathways advice. On average there has been over a 10% reduction in accepted referrals.
Specific examples: HealthPathways:
Reduced MRI knee, MRI L-Spine and U/S shoulder referrals by creating Knee, Shoulder and L-Spine HealthPathways
A reduction in demand of 82%, 70% and 92% repectivly resulted in a theoretical saving of £374,424 on diagnostic imaging on an annual & re-occurring basis but more relevantly freed up of diagnostic capacity has was invaluable in supporting COVID recovery. All without an increase in orthopaedic knee, shoulder or physio referrals and a <5% increase in spinal referrals.
Interface GP:
Triaging to HealthPathway advice reduced hip referrals by 18%, knee referral by 8% and shoulder referrals by 11% preventing these patients waiting unnecessarily on an orthopaedic waiting list for over 2 years.
Supportive feedback ensured re-referral rates of 11.3% in the subsequent 6 months and increased used of community services.
Utilisation of the relevant HealthPathways increased by over 60%. Resulted in an annual and recurring cost benefit of £38,963.
Spread: HealthPathways was procured in early 2023 by the Welsh Government and is now available to every Health Board in Wales. As the other Health Boards within Wales adopt HealthPathways the clinical pathways developed by CAV UHB are visible to all and are the starting point for regional localisation. The management and referral guidance will allow Health Boards to triage referrals and obtain the same referral reduction benefits. The Welsh Government has also provded funding for Interface GP posts in each Health Board.