Supported by Nations Healthcare


  • Bob Ricketts, head of access policy development and capacity, Department of Health
  • Chris Hannah, former chief executive, Cheshire and Merseyside SHA
  • Ian Donnachie, senior vice president, Nations Healthcare

Winner NHS Forth Valley

Self-referral to physiotherapy has been avoided because of fears it would fuel unsustainable demand. But this programme shows that it does work - demand remains stable, workloads reduce and patients get quicker access

This award winner set out to extend the considerable benefits of GP open access, such as greater customer satisfaction and efficiency

The project began with a three-year pilot study, which showed that in one location at least, self-referral to physiotherapy did not result in more referrals. To test this further, Forth Valley launched a larger study in 29 locations chosen for their socio-economic and geographic variety.

Self-referral services were set up, data gathered, and the impact on GP workload and cost investigated. Forth Valley compared the type of complaint and the demographic and clinical profile of the patients who were referred.

The result was unprecedented - reliable information about average national referral rates for urban, semi-rural and rural areas. This showed that in fact referral rates did rise in just under 20 per cent of sites.

However, these sites had a history of below-average provision, and the rise merely put them in line with national rates. In the other sites, referrals did not increase.

Those who self-referred were different from patients who were referred by their GP. Their problems were equally severe, but more recent. They took less time off work, were less likely to miss appointments, achieved better outcomes and were happier with the treatment they received.

There was a significant cost difference. Self-referral cost on average£66, whereas GP referral cost£89. At a national level, this equates to a saving of around£2m a year.

The project shows that self-referral is feasible, appropriate, and acceptable to both patients and providers. It allows significant savings in terms of GP time, prescribing, investigations and demand for secondary services.

Evidence of the project's impact came with the healthcare outside hospitals white paper, Our Health, Our Care, Our Say. This includes a commitment to introduce and evaluate a number of English pilots for self-referral to physiotherapy. NHS Forth Valley is working with the DoH on these pilots in an advisory capacity.

Patient self-referral to physiotherapy, contact

Highly commended The Newcastle upon Tyne Hospitals Foundation Trust

This service has improved the experience of patients with lower gastrointestinal tract complaints by streamlining the path to investigation and diagnosis

The service was prompted by rising demand for endoscopic services, combined with a lack of capacity to expand the service in hospitals.

Flexible sigmoidoscopy is a procedure that can be safely performed by a fully trained nurse. However, until now, nurse endoscopists have not worked independently in primary care.

The one-stop nurse-led service provides a complete, flexible sigmoidoscopy service in a primary care setting - and fast-track referral to secondary care when serious pathology is identified.

As well as sigmoidoscopy, the service also offers information and advice around issues such as diet.

To measure the success of the initiative, an audit of patients who attended from March 2004 to March 2005 was done. The full analysis is not yet available, but it is estimated the procedure costs£270 in a primary care setting, compared with£396 in hospital.

Over a quarter of patients requiring follow-up care are seen by the nurse-led clinic, freeing capacity in consultant clinics.

Patients were keen on the approach, with 99 per cent saying they preferred to be seen in a community setting.

The median time for diagnosis of colorectal cancer to referral was 26 days, compared with 65 days at that time in hospitals.

Nurse-led patient sigmoidoscopy in primary care, contact

Finalist Watford and Three Rivers PCT

Pathfinder practice, a PCT-led medical service, tackles inequitable healthcare and inadequate patient choice in a deprived area, South Oxhey

South Oxhey's three GPs were stretched to capacity. Then came an influx of care home residents, transferred from Northwood.

Pathfinder practice was devised as a long-term solution to the problem. It offers a full GP service as well as clinics for children, pregnant women, people with diabetes, asthma, hypertension and patients needing minor surgery. Many people with long-term conditions have gravitated to the practice, where they are encouraged to manage their condition better with support. In the first eight months, the list grew to 770, with a spare capacity of 1,500.

Pathfinder practice, South Oxhey, contact

Finalist Birmingham East and North PCT

Provides nursing home residents with joined-up, consistent services and access to consultants, which prevents inappropriate admission to hospital

Many homes offered palliative and end-of-life care, but few had the expertise to take a co-ordinated, multidisciplinary approach.

The focus of the project is a redesign of services to benefit older people. Targeted and appropriate services are provided in a primary rather than a secondary setting. Greatly improved partnership working has begun between GPs and elderly care consultants.

Protocols streamline the admission and discharge of residents. Success is measured through audits of hospital admissions, GP visits and complaints.

Nursing homes local enhanced service, contact

Finalist Mid Essex Hospital Services Trust

The trust has taken a service that was not meeting best practice guidelines and turned it into one that has won praise from the Department of Health

Among key objectives for improving the fractured neck of femur pathway were clinical input at the admissions phase to reduce delays, optimal, consistent and measurable outcomes, and a wait of no more than 24 hours for surgery for the medically fit. The service is run by the multidisciplinary team (MDT) but is consultant-led, which provides strong leadership.

A dedicated MDT trauma meeting takes place every day to ensure clinical decisions are made and treatment plans updated.

The average stay for patients with neck of femur fractures has dropped from 19 days in 2004 to 16 days in 2005.

Improving the fractured neck of femur pathway, contact