Yorkshire e-consultation scheme extended

An e-consultation system that helps specialists to decide whether GPs should refer a patient for hospital care is being extended.

Since 2007, Bradford and Airedale GPs using TPP’s SystmOne have been able to use the e-consultation service to seek advice from consultant nephrologists at Bradford Teaching Hospitals NHS Trust about patients with chronic kidney disease.

The service has since been expanded to GPs working across the NHS Airedale, Bradford and Leeds Primary Care Trust Cluster, and to a further five specialisms, with rheumatology joining the e-consultations catalogue imminently.

The first ‘GP with a special interest’ providers are also due to be included from 1 July.

The scheme, which was recently highlighted as an example of good practice in the NHS information strategy, enables GPs to share a patient’s primary care record with a specialist, before making a referral.

Dr John Connolly, clinical lead for technology at the cluster, and one of the leaders of the project, told eHealth Insider that he was “excited” about the inclusion of GPSI services into the catalogue.

“GPSIs work at the interface of primary and secondary care and they’re good at knowing what can and should be managed in primary care,” he said.

“Since the original pilot in 2007 we have shown that there is massive potential for the clinical data that GPs use in normal office hours to be exploited in other situations, especially the ‘out of hours’ setting and the acute sector.”

The e-consultations system replaces direct hospital referrals or email and telephone communications, which Connolly said were “often unreliable”.

GPs pick up the catalogue from within their clinical system, choosing the pathway they want to use. This gives them access to the algorithms the consultant leading the service wants them to use when deciding whether to make a referral.

After confirming that the e-consultations route is the most appropriate for their patient, GPs gain the explicit consent of the patient to share their record with the specialist department, which subsequently creates workflow in the consultant’s unit.

The scheme is now deployed across the 81 GP practices in the area that use TPP’s system, and the specialities covered have expanded to cardiology, endocrinology, diabetes, haematology, hepatology and, imminently, rheumatology.

Dr Connolly, a GP at The Ridge Medical Practice in Bradford, said referral behaviour is improved as “consultants can view test results, the history and pattern of patient care” and advice on possible medication changes or treatment that can be handled in primary care.

“We are not trying to tear down the outpatient department but we believe a small proportion can be managed without ever attending the hospital,” he said.

“Consultants can make better decisions with access to the whole record and it consolidates their working relationship with GPs.”

The system has a target turnaround of seven days and payment occurs through a locally agreed tariff of £23.

The project leads are in discussions with other specialities, such as paediatrics and radiology, and would like to extend the scheme to other new areas.

Dr Connolly said patients had responded positively to the initiative. “Patients expect the NHS to be as technically enhanced as other areas of their life, whether it’s shopping, banking or travel,” he said.