Continuum of care

Convergence with other programs of work

The diagram below illustrates the relationship between the clinical pathway and shared care programmes of work. Clinical Pathways and/or Shared Care may well be a precursor to a referral (i.e. a decision is made to refer for another service to contribute to the patients care). There may also be a need in the future to embed clinical pathways into eReferral forms. Already, discussions with Dr Andrea Steinberg and Dr Kim Bannister from the pathways group has resulted in simple modifications to part of the Gastroenterology, Skin Cancer and TIA/Stroke referral forms.

These modifications in the first phase of the eReferrals project incorporate the Pathway model where possible, without compromising the primary purpose of the referral. None of the three streams of work are mutually exclusive and all contribute to the patient's continuum of care. The communication between the Clinical Pathway group and Clinical Panel will continue throughout the ongoing development of the eReferrals solution. Dr. Kim Bannister, Clinical Panel member says that working on both the eReferral and Clinical Pathway projects has highlighted the synergies between the two workstreams. “What we have found is that the Pathway work often includes a referral component which is enabled and supported by an eReferral process — when it’s aligned with the Pathway,” says Dr Bannister.

“The clinical networks which have been formed for the Pathway working groups are an efficient and useful way to agree on the components and design of the e-referral service-specific templates, in part because they include representatives of both GP and hospital based clinicians. It is possible to include specific help in the eReferral template for referring GPs to easily follow an agreed pathway when making a referral, so that it becomes an educational process for the GP, as well as improving the quality and appropriateness of referrals.”“We can see a lot more scope for development of this work in many other pathways requiring referral between the sectors involved in managing a patient.”