Primary care and secondary care service providers will have different drivers for implementing a CAS, but they should all have one common aim of ensuring that the patient gets to the right place - first time – every time.
One important point to consider, before deciding on whether or not to use a CAS, is the likelihood of a referrer selecting the correct service(s) for the patient, providing they have the correct supporting information available at the time of referral. If all (or most) referrals will end up in the correct service, then a CAS is unlikely to be a cost-effective way of managing the pathway and will introduce a delay to patient care that may be hard to justify.
If, however, patients frequently end up in the wrong service, or referrals are often rejected or need to be re-directed into the correct service, then one way to deal with this may be to set up a CAS. It is important, however, to consider other possible causes for inappropriate referrals, which may need to be addressed.
These may include:
- services being named ineffectively (such as not following the national naming convention or not clearly identifying to referrers what the service covers)
- the service details not adequately describing the referral criteria
- referrers being unaware of how to access referral criteria/information from within the NHS e-Referral Service system.
In many cases, introducing effective clinical dialogue (between referrers and providers for example) may help educate referrers of the correct pathways and services to use and be more cost-effective than introducing CAS. The use of the Advice and Guidance function in the NHS e-Referral Service may help facilitate this dialogue.
A CAS can play an important role in helping manage many care pathways, including:
- enabling any pre-requisite tests or investigations to be completed for specific pathways and protocols, which will ensure that first outpatient appointments are not wasted
- allowing complex cases to be assessed to ascertain the appropriate pathway, before the patient attends;
- supporting more cost-effective commissioning, by ensuring that the patient is seen in the right place, at the first attempt
- preventing provider-initiated cancellations and rejections (after the patient has already booked their appointment), if necessary requirements have not been met