Why the next phase of elective recovery requires a new operating model
Across the NHS, significant progress has been made to improve referral management through single points of access (SPoAs). Yet in many cases, these services continue to operate within the constraints of the traditional outpatient model.
Referrals arrive through a central route, are reviewed, assigned to a specialty and placed into another waiting list. While this can improve consistency and administrative efficiency, it does not fundamentally change how patients move through care. Patients are still directed towards appointments before they have reached a diagnosis or clinical decision.
As demand continues to grow and services face increasing workforce pressures, healthcare systems need to move beyond referral management and focus on pathway management.
The question should no longer be, “Which clinic should this patient attend?” Instead, the question should be, “What is the quickest route to making a safe clinical decision?”
From referral management to clinical decision management
A traditional outpatient pathway typically follows a familiar route:
Referral → specialty → appointment
In contrast, a digital SPoA focuses on:
Referral → information gathering → diagnostics → clinical decision → appropriate care setting
This may seem like a subtle difference, but it fundamentally changes how care is delivered. Rather than directing patients immediately into specialty-specific waiting lists, a digital SPoA coordinates the activities required to reach a diagnosis and clinical decision as quickly as possible.
This can include structured questionnaires, digital triage, diagnostics, virtual specialist review and multidisciplinary collaboration before a traditional outpatient appointment is ever required.
The result is a pathway designed around decisions rather than appointments.
The opportunity for integrated care systems
The greatest benefits of this approach are likely to be realised when digital SPoAs operate at an integrated care system (ICS) level rather than within individual organisations.
Today, patients are often constrained by organisational boundaries. A referral is typically directed to a specific provider, where progress is determined by local capacity rather than wider system capability.
An ICS-level digital SPoA creates a different model: patients enter a single regional access route.
Referrals are assessed against consistent criteria. Diagnostic and clinical capacity becomes visible across multiple organisations. Community, diagnostic and acute services operate through a shared workflow, enabling patients to be directed to the most appropriate service regardless of organisational boundaries.
Instead of asking which hospital should see a patient, the system can focus on identifying the fastest route to diagnosis and then determining where treatment should take place.
This represents a shift from organisation-centric care to pathway-centric care.
Separating diagnosis from treatment
One of the most powerful concepts outlined in the pathway redesign playbook is the deliberate separation of the pathway into two distinct stages.
Stage 1: Referral to diagnosis
The objective is to obtain the information required to make a clinical decision as quickly as possible.
This stage may involve:
- Digital triage
- Advice and guidance
- Community assessment
- Diagnostic testing
- Virtual specialist review
- Multidisciplinary decision-making
Importantly, patients do not necessarily enter a hospital outpatient pathway during this stage. Instead, the SPoA acts as a system-wide coordination function, ensuring the right information reaches the right professionals at the right time.
Stage 2: Diagnosis to treatment
Only once a diagnosis or decision has been reached does the patient move into the most appropriate onward pathway.
This may include:
- Secondary care treatment
- Community-based intervention
- Self-management support
- Voluntary and community sector services
- Monitoring programmes
- Discharge back to primary care
This approach prevents large numbers of patients entering hospital waiting lists before it is clear that hospital treatment is actually required.
A digital front door for healthcare
To support this model, the SPoA becomes a genuine digital front door for healthcare services.
Its role extends far beyond referral allocation. It should be able to:
- Receive referrals electronically from multiple care settings
- Gather additional information through digital questionnaires and structured assessments
- Support rapid clinical triage
- Trigger appropriate diagnostics
- Route patients intelligently to the most appropriate service
- Track patient progress from referral through to diagnosis and outcome communication
For patients, this creates a more joined-up experience. Instead of navigating multiple organisations and repeating information at each stage, they experience a coordinated pathway focused on reaching the right outcome as quickly as possible.
Digital infrastructure makes it possible
A model built around clinical decision acceleration cannot be delivered through manual processes alone.
An effective digital SPoA requires technology capable of supporting real-time referral management, shared clinical information, diagnostic workflow management, cross-organisational collaboration, patient communication and pathway tracking.
Without this level of digital orchestration, organisations inevitably revert to sequential processes, administrative hand-offs and specialty silos.
With digital workflow, diagnostics can be initiated earlier, clinicians can collaborate asynchronously and decisions can be reached sooner.
Building the future operating model
The future of elective care will not be defined by how efficiently organisations manage waiting lists. It will be defined by how effectively healthcare systems help patients reach diagnosis and clinical decisions.
A digital SPoA provides the foundation for that future. By coordinating information gathering, diagnostics and specialist input before patients enter treatment pathways, Integrated Care Systems have an opportunity to improve productivity, reduce unnecessary outpatient activity and make better use of scarce clinical resources.
Most importantly, it helps achieve the primary objective of pathway redesign: ensuring patients reach the right clinical decision in the shortest and safest possible time.
In the guide, Feedback Medical describes the digital SPoA as the operating system for referral-to-decision pathways. As healthcare systems continue to look for sustainable ways to improve elective performance, that vision offers a practical blueprint for regional transformation at scale.