How to reduce rejected referrals in Community Health Services

 30th January 2025

Written by Dr Raj Shah (Clinical Director for Newham and Bedfordshire Community Health Services), Dr Alex Harborne (Clinical Director for Tower Hamlets Community Health Services), William Diaz (Improvement Advisor) and Clarissa Sørlie (Improvement Advisor)

Rejected referrals are a complex problem that affect referrers, community health staff and service users. Colleagues from across Community Health Services in London and Bedfordshire met to share learning and ideas about how to tackle this issue.

 

The Problem

A service user’s journey through community health services begins with a referral. If this referral is incomplete or fails to meet the service criteria, the entire process is delayed. Rejected referrals are a multifaceted problem that present significant challenges for everyone involved. For referrers, the process of drafting a referral that is ultimately rejected represents wasted time and effort. This can compound the strain on clinicians’ time in busy primary care or hospital settings. For community health staff, time spent reviewing and rejecting unsuitable referrals detracts from delivering care to patients.  However, the consequences of rejected referrals are felt most strongly by service users when their care journeys are disrupted and delayed.

 

Sharing learning

Forty service users, carers and staff from across Community Health Services in Bedfordshire and London came together on Wednesday 29^th January to share about how to reduce rejected referrals. The joint QI Forum, chaired by Dr Raj Shah, heard presentations from three teams who have used quality improvement (QI) methodology to tackle this complex problem.

 

Bedfordshire Chronic Fatigue Syndrome Service

Sharon Eplett (Head of Quality and Performance & QI coach) introduced their project with an aim to reduce inappropriate referrals to Chronic Fatigue Syndrome Services by 10% by March 2025. The team reviewed the Referral to Treatment (RTT) timeline to align with wider Bedfordshire Community Health Services (BCHS) standard and stopped clock at diagnosis in feedback appointments. A new referral form was introduced, which was refined through Plan-Do-Study-Act or PDSA. The team has now achieved 9% reduction in inappropriate referrals as well as 100% of these referrals seen within 18 weeks.

 

Newham Community Therapy and Referral and Assessment Teams

Chris Harvey (occupational therapist) and Nazimah Shipkolye (specialist district nurse and Referral and Assessment Team leader) presented an overview of how they used QI tools to understand the problem of 11% of their referrals being rejected. The team used Pareto Charts to highlight the main sources of rejected referrals and reasons for rejection and prioritise areas for improvement. They also used flow charting to map their existing triage processes and identify opportunities for improvement.

 

Tower Hamlets: Improving Communication with GPs

Dr Alex Harborne (clinical director) highlighted outcomes of a project which reduced rejected referrals by 49% and improved relationships with GPs. Change ideas included launching a podcast for GPs, attending a shared education event with GPs, updating service information on the Trust website and improving the electronic referral template.

For more information about this project, read this article and watch this video.

 

Sharing ideas

After the presentations, attendees had the opportunity to share ideas for reducing rejected referrals. The key discussion points are summarised in the visual below, created by Dr Raj Shah.

 

Figure 1. Visual summarising key takeaways and ideas about inappropriate referrals