Planned Care Changes in Cardiff and Vale University Health Board - Primary care referral information and QI project

Project Synopsis: To provide every GP practice with an individualised report explaining their referral rate statistics to the surgical directorate. Extensive data and analysis provided from each surgical specialty, including USC referral rates and referrals analysed down to a clinical condition specific level. Practices were asked to study the data and undertake a QI project in a clinical area where they were a statistical outlier prior to a repeat data analysis 6 months later. We aimed to increase awareness of referral appropriateness and increase the utilisation of clinical HealthPathways and by doing so increase the conversion rate to interventions in outpatient clinics and reduce waiting lists. Plan: Referral data was sourced from the Wales Clinical Communications Gateway (WCCG) which is the electronic referral system that is the single point of entry for all secondary care referrals. The data was analysed and referral rates standardised by practice populations (per 1,000 registered patients). The data was presented to each practice in a PowerPoint presentation who, having studied the reports, identified a clinical statistic where they were an outlier compared to other practices in the Health Board or GP cluster. A QI project to improve knowledge in that clinical area was undertaken, ideally following the best practice locally agreed guidance in the HealthPathway (a clinical information portal for common clinical conditions), improving patient care and potentially normalising referral rates. 6 months later the data sets was re-presented allowing practice to compare referral rates to previous and see the impact of their QI project. A financial analysis of the changes to referral rates in relation to the QI project was also undertaken. Outcome: The presentations were well received by the primary care community resulting in the majority of practices undertaking the QI projects. A wide variety of clinical conditions were chosen with projects targeting outlying referral activity both below and above the CAV norm. In projects where referral rates were higher than the normal, there was a reduction in referrals of 27%. This resulted in a financial benefit with every £1 spent funding practices to review the data and undertake the QI project saving £2.38 in reduced referrals and lack of need for an outpatient appointment. Spread: The next iteration will provide GP practices across CAV with referral information from the entire health board with practices being asked to study referral rates in medicine, surgery and radiology. To handle the increased data, a dashboard is being created which will allow practices to review their referral rates in real time across all specialties down to a HealthPathway level. The dashboard will also provide practices with alerts when their referral trends are significantly outside the practice's historical norms. Once created, the dashboard will be roll-out across every Health Board in Wales providing national demand data, down to a clinical HealthPathway level. This will enable accurate planning and resource allocation, review variations in activity between Health Boards, enable regional working and asses the impact of the clinical advice in the HealthPathway.