Ensuring equality through standardised referrals in NCL 

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The COVID-19 pandemic has resulted in temporary changes to service provision across North Central London (NCL) to allow health and care services to cope with increased pressures. 

As we enter Phase 2 of the emergency response to COVID-19, the entire system is working across NCL to restore elective services. Acute providers have been collaborating to prioritise their existing waiting lists and will work together to clear the backlog using a clinical prioritisation framework. 

As the COVID-19 pandemic continues, capacity across health and care services will be variable, in part due to national infection prevention and control guidance. We are committed to providing safe care for all of our patients and residents, and as such need to reorganise how some of our care is delivered. 

Restarting elective work is not about returning to business as usual and we must ensure that this is done safely and equitably. As part of this:

  • our hospitals need to work differently, having designated IPC status of COVID-19 positive or negative
  • we have to develop systems that will enable us to manage elective treatment as well as future COVID-19 surges
  • take account of productivity losses arising from infection, prevention and control implementation
  • we need to prioritise existing work, referred into the system before COVID-19

In addition, primary care will need to play a role in the recovery efforts and the initial ask is to streamline referrals that are added to the existing backlog. It has become clear that in order to effectively restart activity in NCL, a referral support service (RSS) is now required in each borough, aligned to a single operating model. By streamlining and aligning referrals across NCL, we will be able to ensure all patients have equal access to treatment as services reopen. 

A key reason for the change is that with service provision likely to vary depending on infection prevalence, it would be excessively complex for a single GP to be aware of the new referral thresholds and pathways at any given time. To assist with the restoration of services and to support GPs across each borough, we are working at pace to streamline referral support across NCL. 

NCL CCG is doing everything it can to manage the interface between hospital and GP services so as to minimise any impact on GP practices from these new ways of working. The referral support initiative is one that invites local participation, local leadership and system collaboration. 

The first step is to extend referral support into the two boroughs – Haringey and Islington – that have not historically had a formal support service. The three existing RMS services in Barnet, Camden and Enfield, are all different, each with their own strengths. We will be looking to adopt best practice from our existing referral management systems to create an NCL standard operating model. 

NHSE/I have recommended that from an IT perspective, the preferred IT model is one where GPs use e-RS to access the referral support service. The new Haringey and Islington Referral Support Service will adopt this approach, staffed by local GPs from Haringey and Islington.

There is no plan to change our existing providers of the referral support services.  We will, however, need to continue with delivery by local borough GPs, with their extensive knowledge of local relationships and local pathways to make this approach work.

We are looking to implement the new referral support service at the start of July 2020 and recognise this is a change for all GPs, but in particular for Haringey and Islington practices. 

We have prepared a short slide deck to provide further information (see Downloads). We will also be publishing and updating an FAQ document that will be made available on the NCL COVID-19 website and local GP websites and intranets. 

If you would like further detail on any of the above, please email any questions through to nclchangeprogrammes@nhs.net


Expiry date: Aug 31st, 2020