The Modern Patient Experience
Bringing referrals into
the 21st century
How to streamline the patient’s journey
from primary to secondary care
“There is a need to provide a logical referral facilitation framework that helps provide opportunities to remodel
the process of referring a patient from a GP for further treatment… A well designed referral facilitation process
will assist health boards achieve benefits across the following key dimensions: quality, access and waiting time
targets, patient experience, effective evidence-based process design, improve data, and improved options.”
NHS Health Scotland
New referral models for
enhanced patient experience
Prompt referral of primary care patients for specialist investigations,
medical attention or services is key to early diagnosis and treatment,
increasing the likelihood of positive health outcomes.
For certain conditions, this may mean the difference between
living a full life and a premature death. A survey by Rethink Mental
Illness has revealed, for example, that early intervention can reduce
suicides in young people with mental disorders by 14 per cent.
But timeliness alone is not enough. Consider these scenarios:
David is referred to a psychiatrist at the
local hospital for his depression. After many
attempts to book an appointment, he sees
another consultant, who prescribes him an
antidepressant, not knowing that he is taking
medicines for a heart condition. David ends up
in A&E due to a drug-drug interaction and must
stay in bed for weeks. He can’t attend counselling
at the surgery or get to work. His depression
deteriorates to the point he needs hospitalisation.
David’s GP logs in securely to the hospital’s computer
system and books an appointment with a psychiatrist
for him. David misses the appointment because he’s
ill but, as the system detects this, he is promptly
called back for another appointment. Meanwhile, the
psychiatrist reviews David’s electronic medical record.
He notices he’s being treated with a heart medication
that adversely reacts with a certain antidepressant.
So, during the consultation, he prescribes a different
antidepressant. David continues to go to counselling
and work. And within a few weeks his depression
In scenario 2, streamlined communication allows for a faster and more efficient referral process,
offering practical ways to achieve greater safety, reduced waiting times and improved patient
and care provider experience – not to mention the potential for cost savings.
So, how do you
get from A to B?
You’ll find this requires major shifts
in how patient referrals work. You should pinpoint areas for
improvement and ways to address them while exploring the
prime elements of quality referrals that embrace modernity.
Referrals should be made only
when needed. eems obvious,
but a paper by the King’s Fund
highlights that over a third
of referrals from primary
to secondary care are made
Of course, whether or not a
referral is necessary depends
on many factors. But certainly a
critical one is the ability of care
providers to gather relevant
patient information at the time
Electronic medical records make
It’s readily accessible patient
data that assists GPs and other
providers in making referrals
only when appropriate.
The referral process becomes
more efficient. Patients don’t
miss out on vital care. All
while freeing up secondary
care capacity and increasing
Electronic medical records don’t just help
with referral necessity. As part of a secure
integrated system, they are critical to
ensuring the accuracy and completeness of
the information transferred among providers.
This information may include a patient’s
current and past medications and care plans,
test results, A&E visits and hospitalisations.
Mental health referrals must also indicate
any physical problem patients have to ensure
all-around, integrated care – something that
over 70 per cent of mental health referrals fail
The above information is not always available
to GPs or other referring providers. And,
when it is available, it often takes time to
retrieve, via letters, telephone calls or looking
through files. Or it may be out to date. But
electronic medical records can be updated in
real time and accessed in seconds.
As a result, referrals can include accurate,
comprehensive and current patient
information, enabling specialists to make
the most appropriate decisions regarding
2. Support accuracy
A modern approach is key to transformation.
Obviously, patients should be referred to the right
specialist or service the first time. How well this is
achieved largely depends on the referring provider’s
knowledge of available options.
Intelligent communication systems can support
providers in this step of the referral process, for
example, by enabling them to timely connect with
colleagues, hospital clinicians and experts for advice.
This way, referring providers are empowered to
make straightforward, informed decisions that are
more likely to lead to positive outcomes, whilst
reducing errors and costs.
“Referral is a key part of the GP role. It is a
process with very direct consequences for
patients’ experience of care, and an important
cost-driver in the health system. Approximately
one in 20 GP consultations results in a referral
being made to another service. It is a complex
area where decision-making involves the
balancing of several competing concerns and
sources of information – not least, the need
to respond to patient expectations versus the
GP’s role as gatekeeper.”
The King’s Fund: The quality of GP diagnosis & referral
An important predictor of quality referrals
is time to first specialist assessment, for
the longer this is the more damaging the
consequences for patients.
According to an NHS Health and Social Care
Information Centre (HSCIC) report, people
with depression and anxiety disorders, for
example, see a specialist up to 90 days, or
more, after the referral. This means they must
go through a period of untreated illness, which
research shows can lead to poor recovery.
What’s more, the longer the time between
referral and specialist assessment, the
greater the likelihood that patients miss their
appointment or decline treatment altogether.
• Provider time is wasted.
• The referral process must restart.
• Patient health is at risk.
But it doesn’t have to be this way.
With communication-based technologies,
the time it takes a patient to book a specialist
appointment following a referral is reduced to
the time their GP needs to make a few clicks
or taps on their computer device to select a
consultant and book an appointment.
• Time to first specialist visit is reduced.
• Health outcomes improve, as treatment
can start early.
• Fewer patients are at risk of falling
through the net.
• Waste of human and financial resources is
4. Reduce time to