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Tag: NHS England

Our AI impact: personalised patient pathways

Posted on by Michael Phillips

This is the second in a series of blogs around PRO-MAPP’s (and the wider healthcare industry’s) actionable uses of AI. You can find the introductory background article here, as well as Part One around waiting list monitoring and management here.

How does a healthcare system achieve ultimate customer satisfaction? These days, it’s achieved through personalising a patient’s journey, from understanding an initial health problem to finding a beneficial solution.

Determining that pathway goes beyond knowing exactly what their symptoms are at that point in time. Instead whole medical histories outline lifestyle choices, personal preferences for treatment, past assessments and surgeries, and everything that providers need to be able to tailor any patient’s care requirements with a personal touch. This personalisation marks a huge difference to make every patient feel thought about; it opens a transparent, comfortable dialogue between them and a healthcare professional from the pathway’s very outset.

But since the arrival of Electronic Medical Records (EMRs), there’s been an overwhelming explosion of data in the healthcare industry for every registered citizen. When you apply that to a nationwide database, such as that of the NHS, it shows the extent of how much personal data is out there. Collating pathways has been a major challenge, and this is where we see a pivotal use case for healthcare AI.

Traditional technology’s insufficient impact

Given today’s potential for advanced data usage, patients have a weight of expectation for the level of bespoke care they receive. Unfortunately this only compounds the difficulty level of operational efficiency faced by the NHS blighted by backlogs and budget constraints.

A streamlined end-to-end clinical workflow per patient comprises resource and task allocations across whole teams. That begins with a clean data repository to make every pathway matter. The trouble with old-school healthcare IT being monolithic systems is not only their large-scale and costly implementations, but their role for storing EMR information still being ineffectual due to siloed and underutilised patient data.

Their lack of flexibility and precision has pervaded as patient backlogs have extended. This is particularly true in the heavy-hit specialism of orthopaedic surgeries; helping complex patients receive pre-habilitation assessment, surgery and post-surgical analysis cries out for real-time data gathering and visualisation. Understanding successes and failures of past surgeries helps clinicians delivery a greater level of service for those in lengthy orthopaedic pathways – and when these insights are collated in nationwide databases, a framework can be applied for better patient outcomes en masse and remove clinic-to-clinic variations.

Surgical evidence offered by AI

The future for standardised pathway success lies in the metrics still, just using speedier automation technology to collect it, and simpler ways to surface and cross-reference each patients’ preferences and health histories immediately. When performance data audits can be collated by AI and housed in a comprehensive database, different arms of the NHS can use such information as a gold standard for orthopaedic surgery pathways.

AI is therefore a boon for registries in its tracking capabilities. It can scan demographics, as well as each patient’s preferences when it comes to each stage of treatment, then segment them for healthcare providers to view when necessary. Particularly when this data is gathered via patient self-reporting, such personalised choices are accurate; in fact, recent studies have shown that patients preferred the empathy and quality of AI-generated social media replies than that of clinicians, identifying the tool’s growing sophistication in increasing satisfaction.

The predictive analytics of AI may feel one of its more alien features. Essentially AI is able to identify potential risks for patients pre-surgery to make sure expectations are laid out upfront, as well as supply directions for seeking further advice, or tweaking lifestyle choices, according to collected medical notes and discharge summaries in post-operative stages. So-called ‘prepared lists’ get automated, ready for trained staff to educate waiting list patients on treatment benefits, risks and alternatives. It limits the operational times spent on producing reports, while laying out accurate predictions for continued care.

PRO-MAPP’s AI journey

Human-led one-to-one care is the ultimate driver of patient satisfaction, and that can be made seamless with administrative tasks eased by AI. PRO-MAPP offers an end-to-end AI-backed solution that enables the design and execution of tailored patient pathways to address high-levels of detail to individual needs:

  • The platform collates eOpNote, Patient-Reported Outcome Measures (PROMs) and barcode scans to craft dynamic dataset visualisations.
  • Our review by the York Health Economics Consortium (YHEC) identified the strength of AI applications in collected self assessments and diagnostics to ensure complex patients receive treatment sooner and ease unnecessary appointment numbers.
  • Complex patients can be determined with an accuracy rating of 98%.
  • AI is able to capture every insight from a surgical workflow in real-time, from resource utilisation to outcome-affecting variables, to offer opportunities for clinical support and pathway improvement.
  • We’ve achieved a target reduction in length of stay of half a day for pre-hab patients, saving £423,500.
  • Our platform has helped increase physiotherapy appointments, adding more than 320 than standard pathways.

AI’s automation is so key for a number of integral changes to improve the NHS. Fast-tracking in-need orthopaedic patients reduces the spend on unnecessary appointments that have stifled the system, and sees the right resources being allocated to the correct surgical practices. More productive healthcare teams are able to make their level of care go further with administrative burdens taken on by AI, and focus on what matters – improving the outcomes and results for patients. A happier health system means happier patients, and AI is marking a turning point in evolving orthopaedic surgery to meet those expectations for advanced care.

Next in the series, we’ll be delving into AI’s speedy adaptability to help health centres conduct same day pre-assessment. To find out more about how PRO-MAPP’s AI use drives personalised patient pathways, get in touch!

Our AI impact: waiting list monitoring and management

Posted on by Michael Phillips

This is the first in a series of blogs around PRO-MAPP’s (and the wider healthcare industry’s) actionable uses of AI. You can find the introductory background article here.

Where waiting list management has halted

Most of us have been patients in the hospital waiting room. Whether sitting directly in the lounge for emergency services or being in the backlog for a more intense planned operation, a lot of us unfortunately have tales to tell about waiting times. Some can be horror stories.

In the UK, the National Health Service has carried a huge load; a mountain of intensive human and material resource usage on both critical and non-critical patients. The average GP surgery has more than 2000 registered patients, where any tailored assessments have to account for tests, evaluations, hospital space, and rehabilitation. Orthopaedics are commonly slow due to infamous multiple assessments for a patient’s surgery validity, implant costs and staff training. So much so that the speciality comprises the nation’s longests lists. Hip and knee replacement costs 1.5% of the NHS’ entire budget. There’s also spinal surgery or life-altering trauma cases to think about.

Restricting waiting list bottlenecks and ensuring every urgent matter gets prioritised calls for operational efficiency in triage – basing assessment or event treatment on how urgent a matter is. This has a positive domino effect on secondary or tertiary care freeing up resources for trauma and orthopaedic surgery. Understanding what their issue or condition is, where they should go and who they should see takes time to guarantee that every need is met. Managing such a data-heavy task is where artificial intelligence tools can step in.

Gaining assessments in real-time

Monitoring patients takes into account their health records, past surgeries or assessments, tests, need for surgery, and ideal pathways (what preferred service they expect during their health journey). It’s not that hospitals do not have this data to hand, but legacy technology has been tough to maintain – growing monolithic structures that lose or silo patient data, and misallocate resources or operational plans to staff. There are also inconsistencies between referrals at regional practices, as outlined by the NHS’ Getting It Right First Time initiative.

Managing these queues becomes unfocused and assessing-low risk cases amasses delays that can have a drastic effect on patients: seeking private service, skipping care altogether, depending on opiates to deal with pain, and perhaps worsening their symptoms.

One true supportive behaviour of AI is its swift data-gathering techniques. Any inputs – including patient questionnaires or assessment or surgery notes – can be collated immediately into digitised databases that are simple to find, amend and share. This can flag critical patients to ensure they’re fast-tracked through workflows that can be easily communicated to both clinicians, support staff and patients themselves. In that regard, AI’s unification of data not only supports risk assessment for triage, but boosts satisfaction in exemplary patient outcomes.

AI-driven waiting list monitoring and management has already reaped rewards in making data-backed decisions in a fraction of human time. In Scotland in 2019, automated AI triage was compared to clinician’s valued opinion on referrals for gastroenterology with positive results, including facilitated communication between primary and secondary care. AI triage has also seen a 77.1% acceptance rate among researched medical staff in China.

In trauma cases where fractures or other serious injuries require immediate surgery, these reactive demands require AI to surface pathway data for smooth scheduling and resource allocation for planned elective surgery, even at short notice.

PRO-MAPP’s AI journey

GIRFT is prioritising standardisation as a way to halt unnecessary delays, where integrating this technology on a nationwide scale lies with healthcare providers supported by AI automations, including here at PRO-MAPP:

  • The platform utilises AI for digital scheduling; collating results from patient intake forms to craft an assessment system for nursing staff to coordinate paths for surgery.
  • AI underlines automated patient-reported outcomes, satisfaction surveys, and operative data reporting without the need for dictation.
  • Assessment for surgical readiness can be decreased from around half an hour to 5 minutes, where operative reports can be billed on the same day as service.
  • Through waiting list monitoring and management, we target to reduce lengths of stay for prehabilitation, as well as wasted secondary care appointments, looking to save the NHS over £1.5 million and counting.

Speeding up triage through digital AI tools is not just down to switching telephone questionnaires to online consultations through apps. It’s about putting data input into the patients’ hands, removing the need for unnecessary in-person checks with doctors and prioritising critical patients for surgery or rehabilitation.

Waiting lists are the major operational dilemmas for the NHS – where AI’s help revolves around identifying critical clients and reducing resources of staff costs that take away from efficient orthopaedic surgeries. When those are saved, staff training classes and patient accommodations can be met more suitably which, when rolled out to other institutions, can standardise data collection and usage and reduce the burden of queues all around the nation.

Next in the series, we’ll be delving into AI’s personalisation capabilities to streamline patient pathways. If you’d like to know more about how AI drives our waiting list monitoring and management, contact us today!

4 key healthtech areas PRO-MAPP have impacted through AI

Posted on by Michael Phillips

Healthcare systems are consistently under strain, and alleviating cost and resource pressures comes down to efficiency. Improving those workloads has to take into account every single key worker in the system – doctors, nurses, surgeons, and administrative staff in both primary and secondary settings – which is a conundrum better solved through a commodity helping operations in many sectors: data.

Data is everywhere. But its abstract form can be confounding, especially when advanced data usage nowadays brings artificial intelligence into the conversation. If we can even cast our minds back to the pre-AI age, ‘Expert System’ was a similar concept used to code rules (essentially cloning senior staff’s expertise and judgements) which, when applied to a given scenario, would aim to give medical staff repeatable support and success in decision making

As is typical of any new digital invention in fashion-led IT, AI carries the paradox of being an exceptional helper that requires a great deal of explanation to healthcare staff and patients. Its use for the everyday is more commonplace than ever, but most patients may still be put off by receiving recommended treatment from an output-generation machine.

The key idea to reinforce is that AI is a “supporting tool”, not a replacement for the services of expertly-trained doctors, or conscientious experiences carried out by healthcare staff. What we’ve read about AI’s most actionable utility – trawling through millions of datasets in seconds, such as patient records or imagery – can collect relevant high-quality insights and efficacies helping clinical decision-making to better satisfactory patient pathways and outcomes.

From the health professionals’ side, we see many FAQs around the technology and its effects on operational efficiency:

  • Can we use AI enabled solutions safely with our patients and staff?
  • What’s the impact of costs, implementation and (ultimately) patient outcome?
  • How complicated is this to set up, and how quickly do we see the benefits?

These are all valid, and can be answered from PRO-MAPP’s two years of practical usage. When combined with our proven health platform, safe AI can enhance key functions to collect the right data at the right time and provide effective insights and actions for ‘next steps’; rapidly delivering solutions covering monitoring, same-day pre-assessment, and reducing large waiting lists without impacting timelines, IT resources or increasing costs.

We’ve had independent confirmation from the positive impact AI can have, and we’ll be sharing a series of case studies and key learning around how we’ve utilised AI solutions within a NHS environment, including:

Waiting list monitoring and management

Orthopaedics are the NHS’ hardest hit waiting lists for knee or hip replacement surgery. Restricting bottlenecks and ensuring every urgent matter gets prioritised calls for AI-backed operational efficiency in triage. Our targets to reduce lengths of stay for prehabilitation, as well as wasted secondary care appointments, look to save the NHS over £1.5 million and counting.

Personalised pathways

Understanding every care requirement and preference helps tailor experiences to every patient. AI steps in to collect self-reported surveys, medical histories, and grant post-assessment recommendations, where we’ve seen 100% of patients being ‘very satisfied’ or ‘satisfied’ with their new pathways.

Same day pre-assessment

Re-testing and progressive ailments are just two side-effects of fractured pre-assessments affected by the weight of backlogs involving crucial and less-crucial appointments. Streamlining necessary in-person appointments is possible – PRO-MAPP has helped decrease them by 75%, while consultants can see up to three patients in the same time as previous pathways to also save up to 75% in clinical resources.

Additionally, our Pre-Assessment Clinical Triage (PACT) programme with Oxford University Hospitals NHS Foundation Trust (OUH) helped raise identification of surgery-ready patients from 28% to 77%.

Future areas of benefit

Analysis by York Health Economics Consortium (YHEC) has spotted how annual costs per patient can be reduced by £749, and the NHS’ future relies on a larger AI rollout for these personalised, patient-centric care across the nation. Predictive analytics can determine critical patients and identify patterns in nationwide databases: improving care pathways without the operational hurdles of legacy healthcare systems.

We’re always striving at PRO-MAPP to rise to the ‘data challenge’ and improve our platform using this revolutionary technology. Check back soon to see our AI past, present and future across these 4 critical areas.

Assessing the long-term healthcare plans of the Get Britain Working scheme

Posted on by Michael Phillips

On 26th November 2024, the UK government announced their Get Britain Working scheme, a £240 million investment to determine and fix unemployment rates and economic inactivity across the country. As part of this initiative, introduced by the Department for Work and Pensions (DWP) Secretary Liz Kendall, the government aims to up-skill healthcare efforts and provide fiscal resources and support for young people and other working-age people unemployed due to long-term illness. 

As Kendall says, “a healthy nation and a healthy economy are two sides of the same coin.” As part of its mission to get around 2 million more people into work and raise employment levels to 80%, the government looks to address waiting lists backlogs that have risen, especially since the covid-19 pandemic. 

There may be a link between long waiting lists and employment levels, considering the number of incomplete pathways NHS England experiences. But cutting down queues is just the tip of an iceberg to alleviate the healthcare system’s range of burdens, and the government will also place an emphasis on preventative care, too, as surgery cannot be the cure for every medical specialism.

A snapshot of statistics

Two of the largest contributors to health-related inactivity and economic decline are mental health and musculoskeletal (MSK) disorders, including neck and back pain, as shown in the data outlined in the scheme’s accompanying white paper:

 

  • > Almost 3 million people are currently not working due to long-term illness – which may or may not be attributed to Covid-related cases.
  •  
  • > 4.1 million employed people also suffer from conditions that can hinder their working ability, which has risen by 300,000 in the last year alone.
  •  
  • > More than 50% of people that are economically inactive due to long-term defects are aged between 50-64, also affecting the lives of families and friends as unpaid carers. 
  •  
  • > The past decade has seen a fourfold increase in 16 to 34 year olds that identify their mental health as the main limiting factor to being able to work – the leading health condition for people aged up to 44 years old.
  • > 40,000 people aged 50 to 64 attributed long-term illnesses to MSK conditions between 2019 and 2022.
  •  
  • > A reported 1 million people are signed off from work due to MSK issues according to the Office for National Statistics, with hundreds of thousands more in backlogs for appointments in England. 
  •  
  • > 33% of working age citizens (not retired) who were out of work were also on NHS waiting lists. This is compared to 19% that were employed or self-employed.

This paints a worrying picture for how a rise in serious conditions contributes to the nation’s ability to work, and in tandem places a huge deficit on a stretched NHS. This also does not take into account several other contributing factors such as orthopaedic revisions surgeries, cancer treatment, or cardiovascular diseases. 

This is why the Get Britain Working plan to get more people back into work that are currently off sick relies so heavily on NHS funding and supportive efforts, from “crack teams” to facilitate high-intensity surgical efforts to shifting to preventative methods that can save future waiting list numbers from increasing again.

The plan in action

Aims at restoring the effects of long-term sickness will soon be underway, with the government taking action fast. Funds have been introduced to cut waiting lists at the 20 NHS trusts experiencing the highest economic inactivity levels. 2025/25 also will see the Department of Health and Social Care (DHSC) receiving £22.6 billion in funds, with a pledged 40,000 elective appointments intended to be added into the NHS alongside 8,500 additional mental health staff.

  • These added resources look to get patients critical appointments more quickly, in a bid to return to the NHS’ standards that 92% of patients should not wait longer than 17 weeks after referral to be treated. In the case of lengthy waiting queues for MSK conditions, a programme involving multiple governmental departments looks to remedy this with an MSL Community Delivery Programme. This cooperative approach is a major contributor to successful healthcare reforms, and here involves the DHSC and teams from NHS England’s Getting It Right First Time programme – a methodology for improving standardised patient pathways through the analysis of benchmarked national data. 

A key advantage of tracking and gathering data from patient outcomes in local areas involves seeing where operational improvements can be made against more successfully cost-effective models. Local populations can benefit from shared pathway intel to design future healthcare programmes accordingly. Community services will not only feel empowered to support hospitals with high areas of waiting times, but regional focuses on employment services can help young people and inactive workers affected by long-term mental and physical health conditions back into work. And, with greater digital methods for early intervention, preventing another surge of backlogs will be possible down the line. 

It’s early days since the DWP’s plans were unveiled, but it points towards positive steps in addressing key challenges faced by the NHS, mostly huge incomplete pathways for those in dire need of treatment and the resulting economic ramifications. We’ll await further actions to see how the initiative is going in the near future.

The need for improved pathways: an evaluation of 2024’s NHS waiting list statistics

Posted on by Michael Phillips

Waiting times for healthcare services in the UK shine a rather worrying light on the difficulty faced by the NHS. The metrics act as a key gauge to determine when, and why, healthcare delivery has become far more stretched. Notably of course, the covid-19 pandemic was detrimental to how critical appointments and surgeries could be conducted, with the influx of ill patients straining NHS England (NHSE) staff to the brink.

In the past decade, waiting list times have doubled. Pre-2020, the number of ‘incomplete pathways’ for patients stood at 2.3 million. As of early 2024, it’s an astonishing 7.64 million cases. This is a significant figure that demands a rethink to improve nationwide NHS operations, resource allocation, pre-assessment triage, and data-led technical training to ensure a positive uptick in the quality of patient and staff satisfaction, and timely access to care.

The short and long term impacts

Over 6 million patients are determined to be in a queue awaiting treatment, and this affects both patients waiting for immediate care and those facing substantial delays for planned appointments.

Urgent and emergency care

At the start of the year, on average, 1,760 patients seeking to see doctors and nurses in accident and emergency departments were waiting for more than twelve hours for admissions. With timely intervention necessary to see to these individual situations can be significantly life-threatening, inefficient patient pathways only contribute to poor knock-on effects for every new admission.

Longer appointment lists

Many services are burdened by unnecessary repeat testing and face-to-face appointments that could be handled over the phone for non-urgent issues. These inefficiencies significantly contribute to long waiting times for patients, often delaying access to life-changing surgical procedures. In July of this year, 76,132 patients waited over 53 weeks just for an initial outpatient appointment—a clear indication of the challenges in accessing even primary care. As waiting times increase, patients’ health conditions can deteriorate, leading to more frequent retesting (as prior tests expire), which only worsens the backlog and further extends queues.

As part of the NHS Long Term Plan community health services are offering complex health care solutions outside of hospitals – at houses, care homes, clinics, community hospitals and schools. As a result of changes in guidance and operations for service delivery, they have also experienced a waiting list increase for over a million patients indicative of continual reform to mitigate the hurdles that affect accessible healthcare.

The most burdened specialities

One of the largest concerns surrounding waiting times are the experiences of cancer patients, all of whom experience high variations in their pathway expectations; as reported in August, 69.2% of cancer patients were treated within 62 days of being referred.

Waiting times in the NHS for orthopaedics, and especially trauma and orthopaedics, have been a significant issue, particularly since the COVID-19 pandemic. It is now the specialty with the longest waiting times, having seen a 35% surge in its waiting lists.

By March 2024, over 800,000 patients were in line for orthopaedic procedures. In part, these backlogs are due to a combination of the healthcare system’s stretched resources, postponed surgeries during the pandemic, a sharp increase in referrals and, in some cases, limited funding. While the NHS aims to treat all patients within 18 weeks of referral, these compounding factors make this target increasingly challenging for orthopaedics.

Orthopaedic surgeries can be major procedures involving lengthy recovery times and require extensive post-operative care that can further strain hospital resources. Conditions requiring orthopaedic intervention – such as hip or knee replacements, spinal surgeries, and complex trauma cases – demand significant surgical time and specialised care that tend to have longer waiting times over interventions that are less resource-intensive.Trauma and orthopaedics also receive increased emergency referrals for acute injuries. This complicates scheduling for elective surgeries, while a high volume of both elective and emergency cases only causes further delays for patients awaiting treatment.

These delays vary across the UK. Some hospitals face longer queues than others due to regional demand, the availability of orthopaedic consultants, or operational capacity. As NHS facilities prioritise those with the most urgent needs, many orthopaedic patients face prolonged wait times, impacting their quality of life and, sometimes, the progression of their conditions.

In addition to the pandemic’s impact, several other factors contribute to delays in orthopaedic waiting times in line with NHSE and Getting It Right First Time (GIRFT) insights, as follows:

  1. Workforce Shortages: A shortage of orthopaedic consultants, anaesthetists, and specialist nursing staff is a prominent challenge identified by the NHSE and GIRFT. Recruiting and retaining healthcare professionals in the field is challenging, while the demand for highly trained specialists is high. A staffing gap limits the NHS’s ability to meet patient demand, especially given the intensity of support required during and after orthopaedic surgeries.
  2. Operating Theatre and Bed Capacity: NHSE and GIRFT emphasise the importance of adequate infrastructure, but many NHS hospitals face limitations in operating theatre and inpatient bed availability, restricting their capacity to perform the necessary volume of orthopaedic surgeries. Trauma and orthopaedics require dedicated theatre time and inpatient beds, which are often unavailable due to competing priorities across specialties. As a result, even if a hospital has adequate staff, it may lack the physical resources to treat all patients in a timely manner.
  3. High Volume of Emergency Cases: Trauma cases, such as fractures and other serious injuries, are often life-altering and require immediate intervention, frequently taking priority over elective orthopaedic surgeries. This reactive demand complicates scheduling and can divert resources for planned elective surgery at short notice. GIRFT has highlighted the need to better separate emergency and elective care separation, which could help streamline orthopaedic pathways while requiring further resources.
  4. Inefficiencies in Referral Pathways and Care Coordination: Pointed out by GIRFT, variations in referral practices across regions – combined with inconsistencies in patient management from primary to tertiary care – can result in unnecessary delays. Patients might be referred back and forth between departments or to external clinics without a clear, coordinated pathway. Standardising and integrating these pathways is a GIRFT priority; streamlined processes could reduce unnecessary delays and provide patients with faster access to treatment.
  5. Demand Outpacing Capacity: An ageing population with an increasing prevalence of degenerative conditions (such as osteoarthritis) has driven up demand for orthopaedic procedures. As this often outpaces available resources and capacity, this leads to longer waiting lists. GIRFT and NHSE recognise the importance of population health management and early intervention initiatives to alleviate some of this demand, but these are long-term solutions that require time and investment.

Both NHSE and GIRFT are focusing on initiatives such as prioritising high-demand areas, and optimising scheduling and theatre efficiency, but until these changes are fully realised trauma and orthopaedics will likely continue to experience longer wait times than other specialties.

Eyes, and policies, on the future

As discussed, non-urgent assessment (led by consultants) has an enforced maximum waiting time of 18 weeks (per NHS constitution), all in a bid to see more patients in immediate need of medical treatment. Given this year’s hefty figures on waiting lists, this cap remains flexible to regular re-evaluations, making sure service quality is incrementally improved to keep up with treatment demand.

As we reach the end of 2024, there’s a brighter outlook given that waiting list projections see numbers dropping below 7.2 million before 2025. Much of this is due to innovations in how caregivers can be more efficient through each stage of a personalised patient pathway; where reporting, operations and resource allocation is streamlined to sustain continuous and speedy patient support. With healthtech providers and policy makers looking to support the NHS’ continuous improvement through standardised practice and nationwide analytical data, waiting list times should hopefully reduce across a range of areas.

The urgency to act has been taken seriously as we exit out of the pandemic’s most difficult hold on NHS services. Collaborations involving digital providers, clinicians, consultants and NHS programmes are leading the way to maintain a more patient-centric healthcare system. By regaining stability, the UK service can grant better outcomes for both hardworking NHS staff and the patients that they serve.

Standardising workflows and ‘Getting It Right First Time’: an overview of GIRFT

Posted on by Michael Phillips

Backed by a range of Royal Colleges and professional associations, the Getting It Right First Time (GIRFT) initiative is part of a suite of programmes developed by NHS England. Bringing together powerful data analysis and reviews, it aims to enable healthcare services to improve patient care and pathways across the nation. 

Let’s dive in to learn more about its origins, plans, and performance up to this point, as well as looking ahead to its potential future. 

GIRFT’s original aims

GIRFT was originally conceived as a pilot methodology for reviewing orthopaedic surgery specialties by Professor Tim Briggs, with its landmark 2015 report coining the term. The research was hosted by the Royal National Orthopaedic Hospital NHS Trust (RNOH) and funded by NHS England. After his team covered more than 140 providers in over 200 hospitals, the subsequent programme (as we know it now) was launched in 2016.

The scheme aims to achieve standardisation for delivering quality patient care across NHS healthcare facilities. Often, clinical practice from site to site can differ greatly, affecting the efficiency of teams, their use of crucial resources, and the level of service they can deliver for patients already experiencing lengthy waiting times for orthopaedic assessments and surgeries.

GIRFT’s greater impact can be felt following the pandemic – a catastrophic incident for patients and NHS staff that faced a battleground each day. Covid-19’s ripple effect has unfortunately seen long physical queues for appointments, but GIRFT’s strategy places staff wellbeing and satisfaction as a high priority, acknowledging the dedication and mental health of key roles at NHS hospitals.

How does it work?

1.Making the most of data

    To outline any discrepancies in operations across the country, GIRFT gathers and analyses national data in line with the methodology’s own benchmarking framework. Different arms of the NHS can compare their performance data against both regional or national standards; this allows them to gain empirical metric-backed evidence to inform the effectiveness of their clinical practice in adhering to patients. 

    2.Teamwork

      Using the combined expertise and support of clinicians and management teams at various NHS trusts, the GIRFT’s recommendations can be put into practice and reiterated to determine the actionable, physical changes to healthcare services beyond the data insights. By encouraging meetings among practitioners, as well as data-gathering exercises and continuous learning, this hopes to rollout more standardised patient pathways no longer marred by diminishing variations. This alliance can contribute to the continual improvement of using GIRFT’s findings to foster better outcomes not just at one institution, but many. 

      3.Strategic plans

        Designated ‘enhanced care’ areas have been established to provide flexible support to those requiring post-operative care. The scheme aims to improve patient management for a range of diverse clinical care scenarios, where appropriate and timely intervention can be applied to meet various degrees of clinical needs. 

        The results (so far)

        The flag posts for better pre-operative assessments include reduced repeated testing, the removal of unnecessary face-to-face appointments, and fast-tracking high risk patients that urgently need to be seen by medical professionals. Plus, when resources and staff hours are implemented accordingly for the right tasks, it can have dramatic cost impacts for an NHS that is unfortunately facing financial burden.

        Initial findings have seen that, particularly within orthopaedics, hospital trusts that have used GIRST’s assessments have saved outgoings ranging between £20 million to £30 million. 

        With greater uptake and collaboration involving other specialised trusts, these reductions look set to become more widespread for financial sustainability across the UK. In order to cover more surgical disciplines, GIRFT released 18 additional national documents in 2024 to analyse current procedures, and recommend improvements to deliver quality treatment to NHS patients. 

        Looking to the future

        The environment for effective patient management has certainly improved through the GIRFT programme, and the post-pandemic era serves as a greater opportunity to be ambitious in getting more NHS trusts on board. 

        The initiative is constantly evolving as surgeries leverage the national data to hand and cross-collaborate to achieve a more effective ecosystem. With uniform pathways, not only can post-operative operations be smoothed for significant cost reduction, but staff and patient satisfaction can be essentially lifted too, revolutionising the running of a stretched NHS.

        PRO-MAPP is pleased to have been chosen in GIRFT’s research as a vendor contributing to optimise patient pathways through our Pre-Assessment Clinic Triage product. Discover the full guide here, and chat to us to learn more about our inclusion. 

        The PACT programme: the next revolution for pre-surgical care

        Posted on by Mash Patel

        In the wake of the COVID-19 pandemic, healthcare systems worldwide faced unprecedented challenges, including surging waiting lists and operational inefficiencies. Oxford University Hospitals NHS Foundation Trust (OUH) rose to this challenge with an innovative solution: the Pre-Assessment Clinical Triage (PACT) programme, developed in partnership with digital health innovator PRO-MAPP.

        To put the technology into action, UOH studied its impact on the care pathways for patients needing complex hip and knee joint replacement surgery, with orthopaedic services being an area of surgery blighted by backlogs.

        Identifying the challenges

        After the pandemic, OUH encountered a 35% surge in waiting lists. This was due to large backlogs, as well as new referrals, which meant that the the existing system was plagued with a number of issues:

        • An insufficient number of patients ‘fit’ to utilise theatre capacity
        • The identification of high-volume, low-complexity (HVLC) patients was inaccurate
        • Patients were repeating pre-assessment clinics (PAC) an average of 3.5 times before surgery
        • Administrative processes were paper-heavy
        • The visibility of patient status between appointments was limited

        A more efficient operation was required to minimise the risks of repeated or unnecessary tests and appointments before surgery, which hinges on the collection of valuable data that can be lost with manual, paper-based systems. 

        Calling on PACT for a solution

        In collaboration with PRO-MAPP, and supported by the NHS Adoption Fund 2022, OUH implemented Pre-Assessment Clinic Triage (PACT) – a digital application designed to maximise the number of patients undergoing telemedicine pre-assessment while awaiting surgery.

        PACT includes a number of key features that look to holistically tackle the problems of burdened waiting lists, including a digital intelligence tool (featuring a comprehensive health questionnaire), intelligent screening and test recommendations, criteria to assess patient readiness for surgery, seamless integration with Electronic Patient Records (EPR) and Cerner systems. PACT also allows for accessibility both in waiting rooms, and at home, which has proven to have a transformative impact:

        Improved Patient Readiness
        The pool of patients fit for surgery increased dramatically, from 28% to 77%.

        Reduced In-Person Appointments
        Face-to-face appointments decreased by 75%, streamlining the pre-assessment process.

        Enhanced Efficiency
        Theatre efficiency improved by 10%, optimising the utilisation of valuable resources.

        High Patient Satisfaction
        100% of patients reported being ‘very satisfied’ or ‘satisfied’ with the new pathway, while 92% found the questionnaire to be ‘very easy’ or ‘easy’ to complete.

        Significant Cost Savings
        Analysis by York Health Economics Consortium revealed an annual saving of £749 per patient, representing a 35% cost reduction.

        Environmental Impact
        The programme led to an 8.8 tonne reduction in CO2 production, equivalent to nine return flights between Paris and New York.

        Making costs go further is a major consideration in relieving the healthcare service. Through PACT, cost efficiency is achieved substantially, with the total additional income gained equalling £791,988. £371,183 came from new patients, while increased elective activity equalled £420,805. Moreover, the reattendance savings per patient amount to £331.26, based on the latest national cost collection data.

        The Role of PRO-MAPP

        As the technology vendor, PRO-MAPP played a crucial role in the success of the PACT programme in improving communication between healthcare staff and patients, identifying complex orthopaedic cases earlier in the pathway, and more:

        • The system was rolled out in just 8 weeks, with ongoing evolution to meet emerging needs
        • PRO-MAPP ensured a seamless, smooth integration with existing hospital systems, including Cerner
        • The intelligent screening and recommendation system powered by PRO-MAPP’s technology was key to improving patient readiness and reducing unnecessary appointments through data-driven insights
        • The ease of use for the digital application’s interface contributed to high satisfaction rates among both patients and staff

        Powered by PRO-MAPP’s innovative platform, further innovations are now looking to be introduced. There are plans for divisional implementation across NOTSSCaN surgical services, trust-wide roll outs to centralise elective access, partnerships with PRO-MAPP for an intelligent Waiting List Manager (iWLM) and the implementation of Patient-Reported Outcome Measures (PROMs).

        After addressing the immediate challenges faced by OUH, PACT has set a new standard for pre-surgical care. As healthcare systems continue to evolve, collaborations like this between forward-thinking NHS trusts and cutting-edge technology providers will be crucial in shaping the future of patient care.

        PRO-MAPP has also helped better identify complex patients and optimise patient pathways in a programme run by York Health Economics Consortium (YHEC), and has received recognition in the ‘clinical redesign’ category for our enhanced pre-op assessment project with OUH and Health Innovation Oxford & Thames Valley at the HSJ Partnership Awards. To find out more, get in contact with us.

        PRO-MAPP for joint replacement surgery: a slicker digital approach to preoperative assessments

        Posted on by Michael Phillips

        As an application merging surgical experience, leading academia and software design, PRO-MAPP is specifically tailored to innovate and improve patient pathways. With healthcare systems under pressure from tight budgets, lengthy waiting lists, and evolving (and often complex) methodologies, the time to solve unnecessary operational lags has never been more striking.

        In light of this, a programme developed by health economic research arm and consultancy York Health Economics Consortium (YHEC), in collaboration with Oxford Academic Health Science Network, placed four evidence-based digital solutions under the microscope for their transformative patient pathway abilities. PRO-MAPP was selected for its focus on preoperative assessment and digital patient outcome reporting, looking to showcase its digital effectiveness against standardised patient pathways for knee and hip replacement – one particular strand of clinical surgery blighted by long waiting times – at Nuffield Orthopaedic Centre.

        The current healthcare burden

        The pandemic’s hit on expanded patient waiting lists has been felt across multiple surgical cases, all equally difficult to solve in light of stripped-back resources and staffing. Existing pathways for joint replacement surgery suffers a range of challenges as a result of (or on top of) lengthy backlogs, including:

        • More than three preoperative appointments being undertaken before patients are deemed fit for surgery
        • Manual investigations being repeated unnecessarily
        • Expired preoperative checks (including blood tests)
        • Needless preoperative appointments being carried out on healthy patients

        Digital pathway solutions can relieve the burden on the entire healthcare system’s human and material costs by simplifying each major step before surgery is carried out: lowering unnecessary face-to-face appointments; speeding up the steps between appointments, vital tests, and possible surgery; reducing the need for repetitive testing and data input; and fast-tracking those most fit or liable for secondary care (complex patients, e.g., those with high clinical frailty score that are over 65 years old).

        Gaining the digital advantage

        The PRO-MAPP application is designed to more swiftly and accurately identify patients fit for surgery and reduce numbers on backed-up waiting lists. Patients can be assessed via web or tablet, having been added to a waiting list following an outpatient visit. Health screening and occupational therapy questionnaires can be filled in on iPads by patients, with assistance available from staff.

        Staff training, individually or in groups, takes 15 minutes on average, and this digital collection aims to accurately guide staff as to which investigations are required before patients leave clinics, including ECD, MRSA swabs or blood tests.

        The digital interface speeds up diagnostics, operational decisions, and ensures complex patients can start preoperative investigations earlier, increasing the probability to be determined fit for surgery sooner. Optimising preoperative assessment can properly segment patients only requiring telephone appointments, saving resources and costs affiliated with necessary appointment visits.

        Complex patients should start pre-op investigations earlier to avoid the risk of changes to health status or expired tests (and the need to repeat questionnaires and checks), as well as increasing the probability of being fitter for surgery.

        In short: what we found

        Based on a sample of 1000 patients, the investigation compared the PRO-MAPP pathway with a standard care pathway for those correctly (or incorrectly) identified as complex or non-complex patients. The number of tests undertaken (e.g. echocardiogram or chest x-rays) was dependent on this factor.

        The study looked to identify the average differences between: patient management costs; the length of a patient’s hospital stay; the number of preoperative tests; the number of preoperative appointments; readmissions; cancelled surgeries; and repetitions for preoperative tests and appointments.

        PRO-MAPP’s identification rate proved 98% correct for complex patients, and 95.4% for non complex patients. The length of stay was, on average, two days shorter for those on the PRO-MAPP pathway, while readmissions were lowered by 0.4%, and 1.3% fewer surgeries were cancelled.

        In all, the PRO-MAPP pathway for knee and hip replacement saved £770 per patient in comparison to the standardised procedure. Per 1000 patients, this marks a difference of £726,944.

        Future-proofing personalised patient pathways

        Reducing the need for unnecessary face to face appointments, the lengths of hospital stays, and training and resources costs, the PRO-MAPP pathway is on course to speed up operations while alleviating budget stresses and achieving patient satisfaction. 92% of patients stated the questionnaire was ‘easy’ or ‘very easy’ to complete.

        Staff similarly felt the bespoke application was helpful for the service, implemented according to speciality, workflows, staff numbers, and the level of training, support or technology needed. With reduced repeated health centre visits, health economic analysis also identified that PRO-MAPP has (so far) saved 51,381.6k of travel; a necessary step in improving climate issues through a reduced 8.8 tonnes of CO2 emissions.

        Efforts are still ongoing to improve interactions between patients and staff, but PRO-MAPP has been included on NHS England’s website as a guide for providers on earlier screening, risk assessment and health optimisation in perioperative pathways. To learn more about our pioneering patient pathway solutions, get in touch with our team today!