FOI Ref: 0219FOI1920

6^th March 2020

Freedom of Information Act 2000 – Request for Information

We are pleased to respond to your request for information and our response is set out below:

Request/ Response

I am writing to request that under the Freedom of Information Act 2000, you provide the following information for NHS Sheffield CCG:

For context, I am looking to gain an understanding of the referral management arrangements across the CCG:

1. Does the CCG have a referral management/ facilitation service? No

If yes 

1. Which organisation/company provides this to the CCG? Please provide, name, job title and contact details for responsible person at referral management/ facilitation service?
2. What commercial arrangement is in place between the CCG and this organisation/company? Please provide details of how this was awarded/procured, what was the procurement vehicle used? Was it procured on an open framework? Which framework?
3. What is the total contract value?
4. When does the current contract expire?
5. How much does the CCG pay for referral management?
6. How is the cost calculated? Do the CCG an amount per referral or on block for all referrals? How much does each referral cost to administer? Does this differ depending on the type of referral?
7. What workflow management systems is used to manage referrals? Docman RMS, Emis etc
8. How does the CCG ensure that GP’s follow local pathways (EBICS/POLCE) or protocols when referring patients to provider organisations?

 If no

i. Please confirm how GP referrals are managed between GP and Provider organisations across the CCG? Does each GP practice in the CCG administer all of its referrals, directly with the provider or ERS? If not how are they managed? Peer reviewed? Checked for accuracy?

All referrals are required to be sent from the GP practice to providers via e-RS (e-referral service. Routine referrals in ten specialties can be sent via the CASES (Clinical Assessments, Services, Education and Support) service which offers consultant-mentored peer review and feedback.

j. How does the CCG ensure that GP’s follow EBICS (Evidence Based Interventions and Clinical Standards, formerly PoLCE this is the referral process for patients needing a procedure where certain criteria or a threshold must be met before funding is approved) or the equivalent standards/guidance in your locality when referring patients to provider organisations?

Referrals for procedures covered by the Commissioning for Outcomes Policy which includes NHSE EBI procedures have clinical threshold forms embedded within a referral letter within the GP clinical systems which are flagged on their system for completion and then should accompany the referral via e-RS  either to CASES if requiring peer review or direct to secondary care if the referral meets the criteria. In addition a simple guide to make it clear to referring GPs of those procedures has been agreed with the LMC. The CASES reviewing GPs are aware of the local policy and the thresholds for their speciality in order to provide advice and guidance where necessary.

Some procedures require referral to the IFR team for prior approval e.g. tonsillectomy or to request exceptionality prior to referral. Monitoring is in place.

The secondary care provider is responsible for ensuring the correct form has been completed and received with the referral. Compliance is reviewed via CCG/secondary care contract meetings.  

3. Please confirm the total number of patient referrals from GP/CCG to provider organisations in 2019?

For the period 2018/19 (1^st Apr’18 – 31^st Mar’19) 26,222 CASES peer review referrals were made.

4. Who is responsible from a CCG perspective for the management of patient referrals? Please provide name, job title and contact details of individual?

Brian Hughes, Director of Commissioning and Performance, Deputy Accountable Officer. Contact via: SHECCG.ElectiveCare@nhs.net

5. Which CCG board member is responsible me for referral management? Please provide name, job title and contact details of individual?

Brian Hughes, Director of Commissioning and Performance, Deputy Accountable Officer. Contact via: SHECCG.ElectiveCare@nhs.net