NHS England Armed Forces Health needed a more efficient and reliable IT solution to support them in processing an increasing number of referrals to their prior approvals service. NHS Arden & GEM’s Clinical Support service, who were already providing the Armed Forces Prior Approvals team, proposed the Blueteq system as a secure web-based solution to support case management.
To facilitate the transition, a skilled project team was mobilised to liaise between the customer, the supplier and NHS England. They also prepared the databases for migration, completed the relevant paperwork, engaged with stakeholders and provided training. NHS England Armed Forces now has a more streamlined prior approval process with accurate and accessible reporting.
The challenge
NHS England is responsible for commissioning hospital and community healthcare services for Armed Forces personnel and their families registered with Defence Medical Services (DMS) GP practices in England.
NHS England Armed Forces Health were receiving increasing number of referrals to their prior approvals service. Prior approvals enable healthcare professionals to request NHS funding on behalf of their patients, for services or treatments which are outside of clinical commissioning policies or subject to eligibility criteria.
The current IT system used by the Prior Approvals team was very laborious, so a more efficient and reliable solution was desperately needed as:
- Each month, the team received an average of 52 applications via a generic inbox and added them to the database manually
- Around 50% of the applications were returned to the referring clinician as they did not contain enough information
- There was no facility for applicants to track the status of their referrals, they had to email the team with any queries.
NHS England Armed Forces Health wanted to be able to track and monitor the throughput of referrals, timeframes and authorisations data. Another crucial objective was for the new system to meet all necessary information governance requirements for keeping patient data secure.
Our approach
Two clinical support nurses with knowledge of the Armed Forces prior approval process and an experienced team administrator were assigned to the project, with oversight provided by a clinical senior manager. They worked with the Armed Forces Health Commissioning Manager who acted as the link to the DMS practices.
In March 2024, an initial meeting was held with NHS England commissioners to introduce the new system. Our administration team collated all the documentation that would be needed to facilitate transitions (the current process and interventions, letter templates etc) and sent them to Blueteq. We also drafted communications to notify NHS providers and DMS practices about the transition and advise of key dates.
Sharing status updates
Throughout the project, we facilitated weekly progress meetings with the customer and Blueteq. A navigation tree was developed, which became part of the status summary screen on Blueteq – enabling the Prior Approvals team to view the status of all the funding requests on the database. All statuses set up on the system are displayed in the navigation tree, along with the number of patients under each status.
Ensuring security and data protection
Access logins for stakeholders were obtained. The Blueteq URL was shared with NHS England to liaise with DMS practice representatives regarding security and access. The team completed the Data Protection Impact Assessment and ensured plans were in place for data migration.
Preparing the database
A critical step in preparation for go-live was to revise the functionality of the Armed Forces database. After closing the final case on the old database in August 2024, IT could begin the full data migration extraction and transfer process to Blueteq. So that they could check the details of a historical application in the event of a query, the team had read-only access to the old database while data migration was in progress. Troubleshooting support was provided during the transfer process including supplementing automated extraction with manual uploads when file path name mapping issues were discovered.
Providing support and training
Prior to go-live, bespoke engagement sessions, led by the Blueteq team and supported by the Armed Forces Prior Approval team, were held with NHS and independent providers and training sessions were also arranged with NHS England Armed Forces panel members. Mop-up sessions were available to anyone who was unable to attend the original sessions.
Once the new system was live, an automated email was set up to inform referrers of the new process. It also signposted to Blueteq for support and to set up new accounts.
The outcomes
The project went live with providers in August 2024, and with DMS practices two months later. NHS England Armed Forces now has a more streamlined prior approvals process and a system which aligns with those used by ICBs. Providers and DMS practices now upload the applications directly to Blueteq. Applicants are able to view the status of their referrals – reducing the number of queries sent to the team. All of this has increased efficiency and improved working relationships with stakeholders.
In the six months that the new system has been in use, the proportion of rejected incomplete referrals has dropped to 20% – ultimately reducing the time that patients wait for approved treatments. The customer is able to manage relevant finance and contracting information, and generate accurate, accessible reports.
Positive feedback has been received from stakeholders. In a feedback form sent to panel members and administrators, the majority agreed that Blueteq has had a positive effect on the time spent managing prior approvals. They rated the training provided before implementation of Blueteq as ‘very effective’ and the level of support received since go-live as ‘extremely helpful’.
"Arden & GEM proposed and drove the implementation of the Blueteq system for NHS England Armed Forces Health prior approvals. The successful implementation of Blueteq has enabled the automation of a previously clunky, labour-intensive process and brought increased functionality and reporting depth. The team were exceptionally supportive and encouraging throughout implementation – driving the process forward and bringing our team along with them through a challenging change in approach."
Chris Phillips, Armed Forces Health Commissioning and Programme Manager, NHS England
Arden & GEM’s Armed Forces Prior Approvals team continues to work closely with NHS England Armed Forces Health, DMS practices and providers to ensure the new process is followed.
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