Dramatically reducing time from GP referral to hospital treatment

The NHS Improvement Plan published in June 2004 introduced the Government’s ambition that by December 2008 no one would wait longer than 18 weeks from GP referral to hospital treatment. To meet the target, South Central SHA established a delivery programme called Transforming Care. The programme used Lean thinking to redesign and deliver sustainable 18-week patient pathways.

NHS South Central commissioned Unipart Expert Practices and Atos Consulting to work in partnership with nine local health communities on 15 projects to deliver the Transforming Care programme in a wide range of pathways across the spectrum of care.

With a clear focus on the patient and getting things right first time, the team began by engaging staff, from all areas and at all levels across the projects, to help identify issues affecting the various patient pathways. Using a Lean approach, our expert practitioners and Atos consultants then worked with staff to define and then implement solutions that would improve quality and productivity across all 15 projects.

Standardised processes were developed that could flex to demand and were sustainable. In the process the teams created extra capacity and reduced costs, crucially reducing waiting times and significantly improving the patient experience.

Our practitioners also focused on building staff capability to sustain and continuously improve the new Lean ways of working that had been introduced.

As a result of our joint work significant benefits have been realised in many areas and across numerous pathways, including:

• 50% reduction in patients failing to attend in a shoulder pathway that allowed for a capacity increase of 3000 new outpatient appointments per year
• Waiting time reduced from 8 to 2 weeks, representing a 75% improvement in lead time in a shoulder pain pathway
• 84% improvement in average referral to treatment time in a Gynaecological department, while reducing the number of follow-on appointments, increased the capacity of an additional 11 consultant sessions and 13 physiotherapy sessions a week
• A Reduction from 44 to 11 weeks waiting time for an Orthopaedic pathway
• Waiting time for Physiotherapy appointments down from 19 weeks to 2 weeks
• 20% reduction in inappropriate referrals
• New follow-up booking procedure to maximise clinical time resulted in the saving of 25 weeks of clinical time per year
• Improved capacity by utilising 15 extra clinic sessions in a Cardiology department that reduced the number of people waiting for treatment by 20%
• Improved baseline performance from 86% to 99.3% conformance to the Department of Health’s national four hour target in an Accident & Emergency department
• Improved value add and resource to improve patient experience, resulting in projected savings of circa £1.2 million on agency staff per annum

Our approach contributed towards helping PCTs and Trusts achieve challenging targets and drive down cost. But, more importantly, it left employees with the skills, tools and confidence to sustain and further develop the processes that they themselves have helped redesign.