Self-referral
Another great way of increasing referral and attendance is to provide a self-referral service. This can be set up in different ways, depending on the referral pathway and admin systems in place. Self-referral puts ‘the ball in the patient’s court’ from the beginning and instills self-management from the outset. (Scroll to the bottom of this article to read how the South Manchester team adopted a self-referral only process and the impact this had:
These could be:
Paper-based forms in waiting rooms, diabetes clinics, libraries, etc. (a sample of this is available by clicking Sample_Self_Referral_Form) - if you would like assistance designing a version for your own are please contact alison.northern@uhl-tr.nhs.uk for further info
Here are two examples from work in Nottinghamshire 1) Form 2) FP10-style
Since the pandemic the use of QR codes has since a huge increase - here is an example of how this coudl be incorporated into a flyer or on a bannerstand
Web-based contact forms - such as MS Forms - here is an example used for MyDESMOND in Wales
Email
Telephone to local coordination office
Even a web-based self-booking system
Remember that if a patient refers themselves, you will need to get hold of their data either by going back to their GP practice or, more effectively, asking them to collect this data themselves like on the Nottinghamshire example above.
An example of how this could be implemented is:
Direct to patient marketing through press releases, and other marketing ideas
Displaying the DESMOND teams telephone number and email at any occasion
Developing and distributing of a self-referral form in the shape of a prescription through practices, pharmacies and community events
Posters, flyers and campaigns across practices, pharmacies and community events also helped to spread the word
Here is an example Implementation Plan for a pilot of self-referral that you can adapt.
This roll-out saw almost a two-fold increase in self-referrals across the same nine-month period from the previous year in one organisation during the Embedding Diabetes Education feasibility study.
2023 - South Manchester Team - Impact Award Highly Commended:
“Our team have revised our referral process resulting in greatly improved attendance, reduced administration for both us and General practice staff, shorter waiting lists and improved attendee enjoyment and satisfaction.
Our team had encountered ongoing issues with a very long waiting list and very poor attendance at most of our DESMOND sessions. We had traditionally accepted referrals from health care professionals within our area (mostly from general practices).
We were receiving large numbers of referrals every month which required a significant amount of administration, unfortunately, only a small percentage of those referred responded to our invite to enrol on a course, of those that did respond to enrol, many then failed to attend.
The result of this was low numbers of attendees (which affected how well the courses flowed), and a resultingly long wait time for those who did want to attend.
Last year I decided to trial changing our referral process to a self-referral option only.
I sent email and written communications to all our GP practices informing them of this change, asking them to provide any suitable patients with our DESMOND information form and a copy of the new self-referral form.
Individuals can then choose to post or email their self-referral form back or telephone us for more information, practices can still help patients complete a form if required, but the patient must have signed it.
Since the changes made, the number of responses to invites to enrol on a course have increased significantly, from around a 10% -20% response previously, to a 60-70% response rate now. The number of referrals we must manage has reduced, freeing up time for our administrator to provide a telephone reminder to people enrolled on courses 1-2 weeks prior to each course. Our waiting list has reduced dramatically.
Practices, who were initially questioning the planned changes have also seen reduced administration as they do not need to send us direct referrals, all practices seem to have accepted the changed process now with no issues.
We are still delivering the same number of courses and have delivered 6 sessions since the switch. We have had an attendance rate of 8-11 people attending every course out of the 12 invited and enrolled on each session.
Our attendance rate was previously between 2-5 people attending for every 12 enrolled.
(We over invited due to poor uptake, we may now have to revise this and only invite the maximum number for each course due to the excellent uptake).
We have also found that because we now have a good number of people attending each course, the session flows much better, with participants being much more engaged and learning a lot from each other.
I also feel that the self-referral process helps participants recognise the need to be proactive and to self-manage their own diabetes, rather than health care professionals making decisions for them.
I have advised the neighbouring teams in the area, regarding these changes and benefits so that they can consider adopting a self-referral system also.”