Changing the sequence: Diagnostic Enhanced Advice & Guidance   

Date

29/10/2024

Category

Bleepa

Feedback Medical

Posted by

Hana Stewart-Smith

By Richard Dulcamara, NHS Partnerships Lead, Feedback Medical 

Lord Darzi’s report into the current performance of and challenges faced by the NHS has highlighted much of what we already know – long waits have become normalised, patient satisfaction with services has declined and things need to change.  

Leaning into digital solutions and the private sector will be key to unlocking a better NHS for all and some of these solutions are already working today – we don’t need to wait and see Labour’s 10-year master plan to start reducing wait list times.   

The state of play  

NHS England e-Referral Service (e-RS) data shows that over 14.6 million referrals have been made via the service so far in 2024, which doesn’t reflect additional local service referrals so only shows part of the picture. Advice & guidance has been widely adopted by general practitioners (GPs), 91.7% indicated they use it in the 2022 Royal College of GPs survey of clinical advisers, to help reduce the volume of referrals to secondary care but there’s still a way to go to alleviate elective wait times.

Data up to June 2024 shows the waiting list rose to 7.62 million patients, with waits of longer than 65 weeks rising to 58,024 and waits greater than 18 weeks remaining around the 3.1 million mark. There’s still a serious backlog that needs addressing.   

NHS England has ambitions of eliminating 52-week waits by March 2025, with its Long Term Plan committed to removing one-third of outpatient appointments in the next five years. There’s also a drive towards utilising more advice and guidance in the NHS.  

On paper, this all sounds great. And, encouragingly, these digital solutions already exist and could be implemented further, to help deliver on these targets.  

We don’t need to reinvent the wheel; we simply need to reorganise, enhance and put diagnostics at the start of the pathway.  

Change the pathway, change the outcome 

The government is highlighting advice and guidance as a solution to help mitigate the national waiting list. However, a more advanced approach, proven effective in pilot schemes, has the potential to further reduce wait times and ultimately alleviate the NHS’s significant appointment backlog.  

The traditional process—from referral to outpatient appointment to diagnostic testing and back to follow-up—can be lengthy and involves numerous touchpoints. However, it doesn’t have to be this way.  

Solutions like Bleepa’s Diagnostic Enhanced Advice and Guidance (DEAG) pathway reposition diagnostics at the beginning of the journey for the 90% of patients needing some form of diagnostics. This approach creates diversions, reducing both time and cost.  

By adopting a symptom-based approach like this, we can eliminate unnecessary outpatient appointments and enable clinicians to make faster, more informed decisions about patient care through greater visibility of the patient journey post-referral.  

In simple terms, by changing the sequence of events and placing diagnostics first, better clinical decisions can be made with access to comprehensive patient data early in the process and this has a bigger impact than traditional advice and guidance.  

DEAG pathways: the journey can start today  

The good news is that under the Elective Recovery Fund (ERF), Bleepa’s DEAG pathways qualify for reimbursement, allowing any Integrated Care Board (ICB) or hospital in England to utilise this funding for reimbursement on the Bleepa technology.  

Via the DEAG pathway, the ERF will also fund ICBs with a ‘diversion payment’ of £206 per patient, for any diversions away from traditional outpatient appointments. And with no limitations on the funding for the number of pathways, or patients on those pathways, the more diversions, the more an ICB will be reimbursed. A great incentive to maximise the positive impact of the next evolution of advice and guidance.  

“Take the best of the NHS to the rest of the NHS” 

If a DEAG was to be adopted nationally, it would require not only a much-needed NHS IT infrastructure update, but also mindset shift.  

This shift has already happened at Queen Victoria Hospital NHS Foundation Trust (QVH) in Sussex.  Insights from a recent Bleepa DEAG breathlessness pathway pilot scheme there demonstrate the effectiveness of implementing an enhanced diagnostics pathway.  

The pilot achieved a 63% reduction in referral to treatment time compared to the 18-week national target – 46 days versus 126 days, an 88% reduction in outpatient appointments and a 45% reduction in diagnostic test wait times.  

Through this pilot, we were able to demonstrate three times the number of pathway diversions compared to standard advice and guidance, which led to the national teams including DEAG in the ERF reimbursement mechanism. Put simply, it works.  

The numbers are encouraging consideration for a national DEAG roll out, with realistic ambitions of an overall outpatient diversion rate of 90%, based on the success of this initial pilot scheme.  

What else would this achieve? A significant revenue uplift for ICBs and Trusts using DEAG pathways, efficiencies in service delivery and ultimately, a better patient experience, with them being spared the multiple hospital attendances and a more streamlined approach to their care with an estimated 63% reduction in wait time.  

During Health Secretary Wes Streeting’s address at the recent Labour Party Conference, he referred to a proposed transformation of the NHS into a Neighbourhood Health Service – a digital health service powered by cutting-edge technology, a preventative health service that helps us stay healthy and out of hospital. This set the foundations for what we’re likely to see over the coming months and years from this new government when it comes to a plan for rebuilding the NHS.  

DEAG has already been recognised by NHSE as a key way to improve efficiency and reduce wait times and so by embracing digital innovation proven to make a difference, we’re heading in the right direction, and now is the time to leverage the technology already in play.