Direct Access Pathway: Developing an innovative direct access patient service

Kelly Backler Lead Respiratory Physiologist, Hinchingbrooke Hospital Trust Lead for HCS Primary Care representative for ARTP Direct Access Pathway:Developing an innovative direct access patient service

NHS Improvement (Lung) Pilot To provide direct access for primary care referrals to Lung Function To increase diagnostic range for GP’s to aid accurate, early diagnosis of respiratory diseases. To reduce costs to NHS Cambridgeshire by reducing inappropriate referrals.

Pre pilot audit Audit C+Book respiratory patients -3 months A proportion of these referrals resulted minor interventions by the consultant. These would have been suitable for management in primary care, if the diagnostic support were available. 30% of referrals were immediately discharged back to the GP

Incentives for GP’s The GP direct referral service offers a two week wait timevseight week wait to Chest Consultation. Quality assured tests are performed with measures of not only Spirometry, but gas transfer and static lung volumes which are not currently available within primary care.

Incentives for GP’s To reduce admissions by providing definitive diagnosis and therefore more appropriate treatment in Primary Care. Patients receive detailed information regarding their results and diagnosis from a specialist. Patient is able to have one to one conversations regarding any fears or concerns regarding their diagnosis.

Cost Savings The approximate current outpatient charge for PFTS is £120 per patient. By contrast, the tariff for new patient Chest consultation is approximately £260 per patient This provides a saving of £140 per referral

Cost Savings • If chest clinic is not required and the patient is not subsequently referred • This results in a cost negative service • If Chest Clinic referral is required the cost of lung function is deducted from the Consultation tariff. • This results in a cost neutral service

Problems encountered The GP’s at first were reluctant to refer. Unaware that the service was for PFTs rather than just Spirometry. Once the individual GP had used our service once they referred again to the service. Some patients were unable to travel

Conclusion • No of Referrals in total – 108 patients • No of referrals needing Chest Clinic follow up – 22 (20%) • No of referrals discharged from Lung Function to GP with no need for Chest Clinic referral and managed in primary care– 86 (80%) • This is an estimated saving to Primary Care of £12,500.

Feedback Questionnaires Both the GP’s and the patients were asked to complete a questionnaire after the PFT appointment. Patients were all very happy with the service. GP’s questionnaires showed high levels of satisfication with the referral process, waiting time, management plan given and outcome of plan.

Feedback Questionnaires • Patient comments • Quick appointment given • Very efficient service • Very good approach • Thank you very much • Staff very helpful • Clear explanation of tests given • GP comments • Excellent service, Thank you • Very useful service • Quick and efficient results

Clinical Physiology Department Respiratory GP Direct Referral Diagnostics – Outcome sheet PATIENT – DOB – HBH Hospital Number – GP SURGERY –

Closer to home diagnostics The next step will be reversing this process and going into practices To perform lung function in the community rather than the patient having to travel This is in conjunction with guidance that diagnostics should be available “closer to home”.

Closer to home diagnostics Previously not possible due to lack of equipment Currently only one piece of equipment on the market that is suitable to provide PFT’s Leasing equipment and factoring in costs to any contract agreements for provision Use existing local services as a framework e.g. Community Echo clinics

Direct Access Pathway: Developing an innovative direct access patient service