Circle Integrated Care

Improving patient choice: Revolutionising referrals with end-to-end digitisation


To provide improved patient choice and experience, Circle Integrated Care (CIC) created an end-to-end referrals process – combining eForms and robotic process automation (RPA) to dramatically reduce administrative delays.

The challenge

As a leading healthcare provider, CIC handles over 100,000 patient referrals every year. Originally, CIC’s administrative teams could only action these during the working day, which caused processing times of up to twelve hours. The process was a manual and time-consuming procedure, taking around 35 minutes per referral – 10 minutes per referral download and registration before passing to triage, with a further 25 minutes of work to complete the full onward transfer to a chosen provider.

The solution

In order to provide enhanced choice and experience for its patients, CIC implemented an end-to-end process, combining RPA and eForms to deliver fully autonomous eReferrals. New to RPA technology, CIC decided to deliver this project as part of an NDL Mentorship Scheme – taking its in-house developer from foundation to practitioner level, while guiding delivery best practices, methodology and replicability. The resulting process is as follows:

  1. Once a GP referral is submitted, RPA bots receive, register, and deliver to triaging clinicians in 3 minutes. The KPI completion deadline for this process is 24 hours – putting 23 hours and 57 minutes back in the hands of clinicians, where administration previously consumed 75% of that time.
  2. Clinicians use integrated and responsive NDL Digitise eForms within CIC’s existing electronic patient record (EPR) to inform their decisions.
  3. Bots record the original referral method, as well as documents required for specific referral packs. A unique identifier is generated for the referral within the patient record - sending them a text message to confirm the triage and referral decision.
  4. Bots then create a unique URL link, allowing patients to select their preferred community provider (sorted by distance and service capacity) through another integrated eForm. No further information is required from the patient as responses are linked with CIC’s EPR.
  5. The eForm shows only available providers with indicated capacity. When a patient responds, bots then start to build the referral pack and covering letter according to each provider’s unique preferences and requirements.
  6. Bots then send the completed referral pack via the provider’s preferred communication channel - whether it be via eRS, post or email. Confirmation letters are also sent to patients. This process takes around 5 minutes.
  7. Once a patient has finished their care episode, they then complete one of two eForms - discharge or request for review. Further RPA processes are triggered to receive and process these documents as required. If a patient is discharged, bots will upload the discharge document into CIC’s EPR, updating the patient file with an automatically generated summary letter, before sending it to the patient and their GP.

"Having had no prior experience of automation, this partnership with NDL through a bespoke mentoring solution has allowed me to develop processes that are directly impacting patient experience. It's great to also see my skills in this area also supporting my operational and clinical colleagues by taking away unnecessary pressure. By engaging with the workforce rather than simply focusing on the technology, I am developing automations that are actually solving real challenges and the ones the workforce really wants to see." Kelvin Wong, Lead Robotic Process Automation Developer

The benefits

The project has been revolutionary within CIC, first launched within physiotherapy but soon to be applied to all pathways. It provides a wide range of benefits alongside its original ambition to provide improved patient choice, including:

  • Patient choice: Patients can now make quick and informed decisions via digital channels if they so prefer, providing more options alongside traditional methods
  • Data accuracy: All referrals are now processed with zero errors, improving both staff and patient experience
  • Response rates: 77% response rate to SMS patient choice eForms, of which around 90% are received back in under 5 minutes
  • Time savings: CIC’s referral process now takes a total of 12 minutes without human intervention, leading to a time saving of over 5,476 working days per year
  • Reporting insights: Full transaction reporting can be generated to compare with administrative processing, as well as bot speed and capabilities to understand capacity and detect deterioration
  • Script replicability: New end-to-end pathways are adapted, tested and launched at CIC within just two days
  • Knowledge & skills: Training and mentorship learnings gained throughout the project provide confidence and technical ability for future innovations

"Automation has truly been transformational to our ability to deliver quick and easy access to great care. This process was one that our staff have been calling out for. They identified early on that we could provide our patients with better information to help them make choices in their care. The reality however was having enough time and people to deliver this. On top of this, the constant pressures of high referral rates which at times can be sporadic left the workforce constantly under pressure and often attending work already behind on very tight timelines. This automation initiative has transformed that." Dan Smith, Head of Operations

What’s next?

Following the project’s success, this highly replicable end-to-end referral process is currently being applied to all other pathways within the organisation. With the process demonstrating the clear power of end-to-end digitisation, the wider Circle Health Group plans to deliver these benefits across its network of 52 hospitals nationwide.

Interested to learn more about Circle Integrated Care’s innovations, and how end-to-end digitisation could benefit your organisation? Don’t hesitate to get in touch with our team, or join us at one of our next public sector events.

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"Our staff now turn up safe in the knowledge that all referrals have already been processed and patients are moving their way through our system. This has enabled them to focus on more patient-facing activities and communication which they find more rewarding and really helps to bring the best out in them."

Dan Smith, Head of Operations