Primary Care clinicians often seek advice from secondary care specialists on how best to manage a patient and, whether it is appropriate to refer them into secondary care.  The provision of this advice and guidance service is currently variable across the systems in the West of England, with a range of digital and non-digital solutions, most of which do not accurately record activity or outcomes.

Solutions used in Bath Swindon and Wiltshire include Consultant Connect and email; solutions in Bristol, North Somerset and South Gloucestershire include electronic referral service (eRS), email, letter and phone, whilst Gloucestershire are using a system called Cinapsis. The variability in solutions results in many inefficiencies which can be addressed using a suitable platform across the region.

An improvement in the clinical communications will enable primary care clinicians to feel confident managing patients for longer in primary care and that when they do refer patients to secondary care, they can have increased confidence that it is the appropriate course of action.

The Programme

This programme seeks to imp[rove clinical communications through the implementation of one system to run in the three systems in the West of England. The system will provide a service for a range of primary care clinicians to request advice and guidance for their patients as synchronous (urgent, live) calls or asynchronous (messaging, not live) calls to a range of acute specialities.

Gloucester has been running a pilot with the Cinapsis platform for 18 months, and have gathered strong evidence of success in terms of user satisfaction and reduction in secondary care referrals as a result.

As a result, all three areas systems have procured Cinapsis under the clinical communications framework. Rollout will commence…


Once rolled out, it will be available to all GP practices across Glos and BSW for most specialities, and for Dermatology queries for BNSSG.  SWASFT will also be able to use it, as will AWP.  Other CCGs in the South West may join in 21/22.

Benefits from the programme

Patients will benefit by only having to go to acute outpatient setting when necessary, reducing unnecessary visits and disruption caused by appointments, including travel and childcare.  This will create capacity in the system to assist managing outpatient waiting lists.

Providing Advice & Guidance on the same digital platform across the region will enable cross cover between smaller specialities and will inceas the the range of  more specialist advice available regionally for primary care clinicians.  It will also enable SWASFT and AWP to access specialist advice and guidance to reduce unnecessary referrals with these providers working across the same geography.

Can we state any actual benefits  already indentified from the Gloucs trial?

Funding and the role of West of England AHSN

This initiative is funded by NHS England /Improvement South-west region as part of a wider programme to implement remote monitoring technologies into virtual care settings. The West of England AHSN has played a leading role in securing this funding, and has guided the joint procurement. Other ICSs in the South West will have the option to buy into the same system at a preferential rate during 2021/22.

Operationally, the initiative is clinically led and there is strong engagement across all three ICS systems, which each one responding to the transformation needs of their local systems. The AHSN is working to ensure that this work is collaborative and that sharing across the three systems and with AWP and SWASFT is relatively seamless. The experiences and learnings from this work will be shared to support implementation in other ICS/CCG/STP areas within the region and beyond.