The data quality pilot aims to provide the tools and methods necessary for primary care clinicians to:

• reduce the amount of returned referrals from referral support services (RSS) by using an approved NCL standard referral form
• facilitate the analysis and planning of care and demand 
• accurately report in-practice demand by:
  • decreasing the use of generic codes (e.g. referral for further care) and increasing the use of QOF and specific referral codes which will allow practices to better understand their referrals
  • decreasing the use of multiple generic codes for a specific referral (e.g. cardiological referral, referral to cardiology)
  • appropriately recording the nature of appointments (e.g. telephone, face-to-face, digital)
• gain better insights into their clinical practice
• help aid delivery planning on an ICS, regional, or even national level
• increase legal safety by appropriately coding clinical practice.

The pilot aimed to trial the introduction of an EMIS-embedded protocol (NCL Referral to Services, see EMIS protocol features) to all primary care practices in NCL, which would support staff creating referral letters by:

•  improving quality of the referral letter and therefore increasing safety and hopefully reducing returned referrals
• speeding up the process to create a referral letter.

It also introduced a Standard Operating Procedure (SOP) showing how to use the protocol, as well as other guidance to be implemented within practices, such as direction for appropriate consultation modes recording and guidance regarding clinical coding.

See the NCL Referral to Services protocol video for more information.

The EMIS protocol has the following features:

• automatically populated practice information (e.g. practice name, address, telephone, email address)
• click-through prompted questions (e.g. referral type, investigations, and consultations notes to add)
• ability to select the type of referral that the referrer wants to make, including Advice and Guidance, Letter to Consultant and borough specific referrals (e.g. cardiology or respiratory) 
• automatically populated QOF codes based on the type of referral being made
• ability to add investigations and problems to the referral; by default, active problems and last year of investigations and values are added, but the user can include less or more at will
• automatically created standard referral form with consultation notes selected by the user
• automatically prompt a task to be sent to admin staff to submit the referral (if the practice requests this feature).

The pilot was conducted with four practices in four boroughs (Barnet, Camden, Enfield and Haringey), with the following results:

• use of the code "Referral for further care" was reduced from 470 uses per month to 115; a 75.5% decrease, meaning on average only 3.47% of codes at these practices were referral for further care, down from 15.2%
• 250 codes changed from “Referral to further care” to codes specified within the protocol
• use of intended codes per referral showed an overall increase in most referral groups (e.g. the cardiology recommended code went up from 12.5% to 25.3%).

User feedback included:

• the new protocol system was given a 4.67/5 average rating, with 89% of users finding it easier to follow than their previous referral process
• 78% of respondents recorded an average time saving of between one to five minutes per referral
• all respondents recommended the continual use of the protocol in their practice.