Claiming Elective Recovery Fund payments for diverting pathways

NHS England has recently expanded the scope of the Elective Recovery Fund (ERF) to cover technology like Bleepa® where it can support diversions from traditional patient pathways, to improve efficiency and deliver better, faster patient care.

How does ERF funding work for advice and guidance?

ERF funding flows directly from NHS England to integrated care boards (ICBs). Advice and guidance services count towards the ERF target for each ICB. Technology solutions which change the patient journey to divert pathways mirror the advice and guidance approach.

Advice and guidance can include any or all recorded clinical dialogue that facilitates the seeking and/or provision of specialist advice, prior to or instead of a referral to secondary care. It includes activity where that advice is expected to support a referrer to manage a patient without the need for an unnecessary outpatient appointment.

What is a diverted pathway?

Within the ERF, diverted pathways are defined as those requests for advice and guidance, where the request has been processed (i.e. received and responded to and subsequently returned to referrer with advice) where it is expected that the advice diverted a referral.

Therefore, NHS trusts are able to count the following categories of activity as diverted pathways:

• The patient is directed back to the GP / referrer without any diagnostics after clinical review – standard advice and guidance
• The patient is directed back to the GP / referrer after relevant diagnostics after clinical review – diagnostic enhanced advice and guidance

What is a diversion payment?

Diversions away from traditional outpatient appointments, such as those achieved by diagnostic enhanced advice and guidance pathways facilitated by Bleepa®, are eligible for a single payment of £206 per patient (diversion payment) from the ERF.

There are no limitations on the number of patients or pathways that are eligible under the funding mechanism, the more activity delivered and diversions achieved the more an ICB will be reimbursed.

How are diversion payments claimed?

In each case, the amount that could be claimed by the NHS trust would only be the equivalent of one first outpatient appointment per patient directed back to the GP. The ERF funding would be payable to the ICB which would pass on the value for diverted pathways to the NHS trust.

Please note this transfer does not happen automatically and needs to be agreed locally between the trust and the ICB.

How are the diversions documented?

Bleepa® includes fully auditable reports detailing each diversion to the ICB ensuring that all closed outcomes activity can be reimbursed.

What is not included in the ERF reimbursements?

Services for patients who are not diverted, and therefore require further outpatient, diagnostic or treatment activity, are out of scope for payment through this initiative.

What might diversion payments look like for an ICB?

An example, based on our case study at Queen Victoria Hospital within the Sussex ICB, shows the reimbursements an ICB could be eligible for:

• 1,000 referrals on a symptom-specific pathway at 90% diversion rate = £185,400

Further information

Further information about the Elective Recovery Fund can be found on the NHS England website here

Understanding diagnostic enhanced advice and guidance

Why opt for diagnostic enhanced advice and guidance?

Over 90 per cent of patient referrals require diagnostic input. So, the key to reducing increasing waiting lists is to enable patients to be seen and diagnosed as soon as possible.

The transformational change needed cannot be delivered by simply spending more or cutting costs – a different approach is needed. Bleepa® has been tried and tested and is uniquely positioned to provide a diagnostic enhanced advice and guidance model for ICBs that recognises the opportunity available to deliver better care for patients.

How does diagnostic enhanced advice and guidance work?

Diagnostic enhanced advice and guidance enables patients to progress straight to diagnostic, multi-disciplinary pathways. Tests, if required, are carried out sooner to enable better and faster clinical decisions to be made on the basis of diagnostic evidence. The need for outpatient appointments is also reduced, optimising the use of clinician time and reducing waiting lists.

Is this the same as the existing advice and guidance? If not, how does it differ?

This is the next evolution of advice and guidance, which provides GPs with all the advice, information, and test results, required to make a plan and diagnosis for patients, in a simple, efficient and cost-effective way, using existing NHS resources.

View a comparison of the existing pathway and diagnostic enhanced advice and guidance here

How do you know this pathway approach will work?

This new approach optimises existing pathways, so that activities that need to be carried out simply happen in a different order to enable faster decision making and diagnosis for patients.

It is a model that has been tried and tested and proven for Queen Victoria Hospital in Sussex, as outlined in the all-party parliamentary group for diagnostics report on community diagnostic centres – where Bleepa® delivered an 88 per cent reduction in outpatient appointments and a 63 per cent reduction in waiting times for a breathlessness symptom-based pathway.

Are there any data privacy/security risks?

Bleepa® is an industry standard, fully encrypted and closed end-to-end solution that exceeds the standards for the NHS Data Security and Protection Toolkit. Developed by ISO 27001-certified Feedback Medical, it offers enhanced security and data privacy, particularly in comparison with paper-based processes.

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