NHS Manchester Referral Management Centre (RMC)

Who commissioned the service and why?

NHS Manchester commissioned Harmoni to pilot an RMC for the city's three practice based commissioning (PBC) hubs - North, Central and South, in September 2010. This followed initial pilot work in South Manchester PBC hub in 2009/10.

The RMC aims to improve efficiency by ensuring that patient care is in the most appropriate manner and in a location as close as possible to the patient's home. Delivering alternative care pathways aims to reduce unnecessary referrals to secondary care.

Overview of Manchester RMC

Harmoni's RMC assists GPs to manage the referral pathways for patients with scheduled care needs. Currently 101 of 104 practices in Manchester use the referral gateway. In the service's first three months, just under 30,000 referrals have been processed.

Practices send referrals to the RMC using an electronic template via a secure NHS.net email account. All IT processes are compliant with the current NHS Information Governance standards and data transmissions taking place over N3.

The triage team then clinically assess the referral request and allocate it to the most appropriate care pathway for the patient. This takes place within an agreed time frame, currently 48 hours.

The RMC notifies practices of all their referrals via email. The service also provides weekly reports that outline the status of each referred patient.

Feedback from referring GPs, the Clinical Triagers and the Harmoni team is helping to inform, improve and clarify local pathways for patients, helping to make the patient journey more efficient.

Outcomes

• Since the service's launch to December 31st 2010, 7% of 30,000 referrals were returned to GPs. The Clinical Triagers identify conditions on the non commissioned procedures list, give advice and guidance on how some patients could be further managed in primary care, and identify any further information required to ensure that the patient is signposted to the correct pathway. The aim is to improve the standardised care to local patients.

• The Associate Director of Commissioning reported that estimated gross savings in the first three months are £1.2m. The main savings made are as follows:

Non-commissioned procedures £632k
Rejected referrals due to incompleteness £132k
Deflections from secondary care £461k

• Projected savings to March 31st 2011 are between £1.8m and £2.2m. The costs to the end of March will be £798k, including initial set up costs of £220k. This gives a net benefit of approximately £1.1m for the financial year.

• The quality of the GP referrals has improved significantly, evidenced by ongoing audits by the Clinical Triagers.

• The referral gateway has been utilised by Clinical Triagers to facilitate increased training and education for themselves and their GP colleagues.

Benefits to commissioners

The referral gateway allows for soft intelligence as well as peer review, along locally agreed criteria. It informs the local GPs and commissioners of the local healthcare needs of their population in real time and enables higher quality clinical care delivery in an agreed collaborative approach. It also enables the redesign of local care pathways to better meet the needs of their patients in a local setting.

Local GPs remain at the heart of the decision-making process, but with the advantage of support from the Harmoni RMC team.

Benefits to patients

Through the support and facilitation offered to their own GP, patients benefit from an improved equity of care irrespective of where they live. They have the ability to access care closer to home, dependent upon their healthcare needs.