Stockport PCT experienced a rise in GP Referral to Secondary Care from April 2008 which coincided with the introduced of Free Choice in the Choose and Book system.

Previously, if a G.P. made a referral to T&O, General Surgery, Dermatology, Urology or Gynecology the Choose & Book system would direct the referral to the local Tier 2 service. In April 2008, 'Free choice' was introduced, which removed this facility on Choose & Book, and referrals to Tier 2 services fell. In the first 6 months of 2008/2009 Tier 2 accounted for just 23% of total referrals, compared with 33% for the same period the previous year.

The PCT wanted to understand the affect of a change in demand on waiting times. The initial analysis centered on the Orthopaedic Assessment Service (OAS), using Scenario Generator, the PCT modeled the contracted throughputs to determine if it was feasible for all patients to be seen within the contracted 4 weeks.

The Approach

The PCT inputted the contracted levels at each stage of the patient journey, and inputted waiting times of:

1. 24 hours from referral to triage
2. A minimum of 3 days from triage to the first appointment, with a maximum length of 14 days, but typically 7 days (to give patient reasonable notice to attend)
3. 18 days from the first appointment to follow up with a window factored in to allow for assumed diagnostics (CONTRACTED)

The pathway is outlined below:

The Results

The results showed that, at the contracted levels of demand and capacity, 97% of patients could be seen within 28 days and 100% of patients could be seen within 37 days.

The Benefits

Simulation and modelling provided the PCT with a means of understanding the flow of patients from referral through to discharge, and the expected time taken during the process. From this position they will be able to go on to examine the impact on waiting times if there is further demand on services, if the service is redesigned, or if there are changes to the capacity available in the system. A similar system can also be used to examine other pathways.

"This has helped us to understand current demand and flow, and will enable us to have a more meaningful dialogue with our providers about future contracting arrangements"

Lisa Maginnis, Analyst, Stockport PCT

Tips for Other Users

"Always start with a simple question first, it will help you define the problem better and focus on the right details to help you get an answer"