Trust centralises and standardises the administrative function with a referral hub, triaging 87 per cent referrals within an hour 

Synopsis:

Programme scoping uncovered a number of areas of concern with the Trust’s current administration arrangements:

• The administrative staff were the least engaged and motivated staff group
• Limited development opportunities
• 40% of complaints to the Trust pertain to the administration
• Inconsistency in policy, process, and procedure across all teams
• Inconsistency in job banding
• Not taking advantage of advances in technology
• Access to services is confusing

It was identified there would be significant benefits to the Trust in terms of efficiency and effectiveness of centralising and standardising the administrative function. Following the successful implementation of the Referral Hub the trust now has:

• A fully engaged administrative workforce who are aware of their performance KPIs and how they are performing in line with these
• Clear induction plan for all new starters
• All staff are working towards the same objectives
• All staff are offered the opportunity to study an apprenticeship
• All staff are working at the same banding, job description and personal specification
• New areas of technology are always being reviewed – we are currently working with “thought my” to ascertain whether a large percentage of our referral registration could be automated
• Access into our service has been simplified with the introduction of one referral form

Ambition:

The purpose of this programme was to:

• Improve the patient experience with regards to customer service
• Improve opportunities for the development of administrative staff
• Reduce the number of complaints received by the Trust
• Reduce the costs of the Trust’s administrative workforce
• Support the implementation of other Trust strategies
• Prepare the Trust for integration with other organisations

The programme aligned with the following strategic objectives:

• Use resources efficiently to enhance our ability to improve services: the programme will allow the administration function of the Trust to operate efficiently and consistently
• Develop the organisational capacity to deliver our vision and objectives: the programme will support the delivery of the Trust’s vision and objectives by promoting excellent support services and organisational ‘front door’; and that functions are delivered by the most appropriate roles.

The programme had the following aims and objectives:

• Create a more efficient and effective customer journey for patients, their carers and/or families, and the public; improving the patient experience.
• Reduce the variation in practice, process, roles and responsibilities regarding administrative processes
• Centralise administrative activity
• Develop a culture of excellence in customer service within the Trust
• Allow HCT to be more flexible to system-wide moves to improve access and integration across the county

Outcome:

E&N ICT has redesigned their access route into their five locality teams, opening a Referral Hub in Stevenage on 23rd July 2018. The Referral Hub performance indicators are all being met.

Telephone calls have risen since opening, receiving regularly receive 6,000+ calls/month (graph 1), with an average answering time of 34 seconds (graph 3). 2,000 new referrals are being received (graph 8) and registered by the administration team within 24-hours of receipt. 87% of referrals are being clinically triaged within 1 hour of receipt (graph 9). Referrers receive an acknowledgement of receipt.

Any inappropriate referrals are identified and a written response is sent out outlining the rationale behind the decision. Referrals are signposted onto the most appropriate service; this information is noted within our referral update letters. Our call prioritising system gives the highest priority to professionals who refer a patient onto our prevention of admission pathway. Professionals hold a clinician-to-clinician conversation, outlining the urgency and the patient’s needs.

The Referral Hub ensures all appropriate referrals are handed over to the locality team within a timely manner with all the required information and documentation in place. This enables the team to focus their attention on providing the required clinical care.

Spread:

The successful implementation plans for the E&N Referral Hub have been used as a project template for the Public Health Nursing centralised referral hubs and the Children’s and Young Peoples Specialist Service hub which opened in January 2019. Working together and sharing lessons learnt has ensured a smooth mobilisation.

The creation of Action Learning set meetings, where the Administration Leads meet on a monthly basis to discuss areas of concerns, staff objectives, performance monitoring etc. has ensured HCT have a standardised access model across all of their services. HCT and Hertfordshire County Council are also working together on recruiting a social worker to sit in the Referral Hub and work alongside HCT’s clinical triage staff which will furthermore improve the patient experience by ensuring they are seen by the right professional at the right time.

This joint working will also illuminate the double up visits as we will be aware of who is visiting when. The Referral Hub, Specialist Palliative Care Nursing and Garden House Hospice have also come together to create the North Palliative Care Referral Centre. Referrals and patient inquiries come into the centralised Referral Hub and are triaged locally by the Duty Team at Garden House Hospice.

Value:

The benefits of a centralised model of customer service include:

• An efficient and effective customer journey for patients, their carers and/or families, and the public; improved patient experience.
• Illuminating variation in practice, process, roles and responsibilities regarding administrative processes
• Economies of scale mean activity could be carried out much more efficiently centrally than locally, resulting in cost savings.
• Sustainability as the model can be adapted in response to future changes within the organisation and more widely in the system.
• Allowed the development of a ‘centre of excellence’ in customer service within the Trust
• Allowed HCT to be more flexible to system-wide moves to improve access and integration across the county
• An initial financial saving of 4.1WTE and £87k
• Highly regarded by national NHS bodies NHSE/PHE. Our Referral Hub has used for emergency scenarios i.e. dental hygienist incident

In our satisfaction survey undertaken in April 2019 which was completed by a range of professionals who utilise the Referral Hub services:

• 80% say they were satisfied with the speed of which their calls were answered
• 88% say they found our caller’s handlers helpful
• 67% say they were satisfied with our speed of clinical triage

Involvement:

Regular attendance at Locality Board meetings ensures all providers are working together for the benefit of our patients. Performance feedback is actively sought:

GP feedback: GPs find the service more responsive. Being able to hand patients over directly to the clinical triage team means they are fully aware of the patient’s appointments. GPs using SystmOne are also able to view our consultation notes.

Patient and carer feedback: Patients appreciate a call to discuss their needs and being given some advice/guidance prior to being offered an appointment. Patients are reassured their needs are being addressed and are kept up to date with when they will be visited.

The Referral Hub is ‘fantastic’. Her experience is that whoever she speaks to is very pleasant, they provide a very efficient service and are always so kind to her.

Staff feedback: Staff like having appointments booked in their ledgers with patients being triaged and seen quicker. Prevention of admission patients are seen in a timely manner. Better time management is reported by staff as there is protected triage time and when our visiting patients it allows them the time to focus their full attention on their patients requiring their clinical skills.