The NHS is navigating rough waters in recovering elective care services. Years of growing demand, workforce shortages, and limited infrastructure have contributed to a backlog that now stretches into the millions. While progress has been made to reduce the longest waits, achieving timely and efficient elective care remains a complex and urgent priority for the NHS – one clearly restated in the NHS 10 Year Health Plan.

The causes of the elective backlog are well documented, including workforce shortages, lack of infrastructure, health inequalities, and growing reliance on the independent sector. However, one issue receives far less attention – the disconnect between primary and secondary care.

The current referral system feels less like strategy and more like guesswork. Too often, referring a patient feels like playing Battleships: you fire off a referral and hope it hits the right service. While the national electronic referral system serves as a communication tool, it does not enforce clinical quality standards. Without clarity and communication, primary care can easily misdirect referrals. Without triage capacity in secondary care, delays and inefficiencies multiply. The result is frustration on all sides.

Current referral processes are not designed for a modern, patient-centred healthcare system.

Now, imagine something different.

What if referrals were more like a game of Chess – transparent, deliberate, and strategic? What if primary care had the tools to see the board clearly, understand the right next move, and send the patient exactly where they need to go – with all the right information?

That’s what we have built.

Our Gateway® products, fully integrated with clinical systems, ensure that the right referral information is captured the first time. Our PathAssist™ tool checks the patient record against agreed clinical pathways and supports a high-quality, targeted referral. Not just “a referral,” but the right referral to the right clinic, with everything secondary care needs to act.

A Dermatology Referral

Let’s walk through a typical non-Gateway® dermatology referral:

1. The patient visits the GP with new or worsening skin symptoms – red, scaly, itchy patches on the elbow.
2. The GP takes a history, examines the skin, considers differential diagnoses, advises the patient, and prescribes topical treatment.
3. The patient returns for review; symptoms are now widespread and impacting quality of life. The GP decides to refer to secondary care for specialist input and asks the patient to continue topical treatment in the meantime.
4. The GP dictates the referral quickly before moving on to the next patient.
5. Administrative staff type up the referral dictation and submit it through the electronic referral system, sending it to the local dermatology referral assessment service – uncertain of the exact subspecialty.
6. The referral enters a busy dermatology referral assessment service queue, where it awaits triage.
7. The patient waits and returns to the GP for an update. The GP arranges a referral to a second provider (Trust 2), hoping for a shorter wait, repeating the administrative steps.
8. A secondary care clinician at the original trust reviews the referral, triages it, and allocates the patient to a routine dermatology appointment. The patient is contacted and booked.
9. At the dermatology appointment, further investigations are ordered to guide treatment. The clinician prescribes interim therapy – often something that could have been initiated earlier in primary care.
10. Meanwhile, Trust 2 contacts the patient with an appointment offer, which is declined since the patient has already been seen elsewhere.
11. The patient is seen back in the specialist psoriasis clinic for follow-up and treatment.

Like a game of Battleships – full of guesswork, duplication, and missed opportunities. Primary care is doing its best but sending referrals into a busy system and hoping they land in the right place. The referral process needs to evolve.

A Gateway® Dermatology Referral

Using our Gateway® products makes referrals feel more like a game of Chess – strategic, informed, and purposeful. Here’s how Gateway® transforms the process:

1. The patient visits the GP with new or worsening skin symptoms – red, scaly, itchy patches on the elbow.
2. The GP takes a history, examines the skin, considers differential diagnoses, advises the patient, and prescribes topical treatment.
3. The patient returns for review; symptoms are now widespread and impacting quality of life. The GP decides to refer to secondary care for specialist input and asks the patient to continue topical treatment in the meantime. The GP uses our Capture app to take high quality photographs of the skin.
4. The GP opens Gateway® and is guided through a series of structured clinical questions – designed by local clinicians – that capture the clinical information needed, check referral criteria, and identify the subspecialty required (e.g., psoriasis).
5. To manage time, the GP allows the administrative team to complete and submit the referral in Gateway®, along with the images.
6. Because the referral contains all the necessary clinical information and is directed to the correct subspecialty, the hospital books the patient directly into the psoriasis clinic – bypassing the need for triage or additional assessment.
7. At the dermatology appointment, further investigations are ordered to guide treatment, and the patient remains under the care of the psoriasis clinic.

This new referral process is much more like a game of Chess – thoughtful, strategic, and precise. By guiding clinicians through structured questions and ensuring referrals include the right information, sent to the correct specialist clinic, Gateway® helps practices make deliberate moves that streamline patient care. This approach reduces delays, removes guesswork, and allows both primary and secondary care teams to work smarter together – ultimately improving the patient journey and outcomes.

Gateway® Clinical Validation (Refer-AL)

How does this all work, you ask?

Behind the scenes, our talented Gateway® developers collaborate closely with local healthcare systems – especially secondary care clinicians – to define and build tailored referral pathways and clinical criteria right into the system.

Enter Refer-Owl – not AI, but smarter. When a GP chooses to refer a patient to dermatology, Refer-Owl steps in to guide them through a series of structured clinical questions, carefully designed by specialists from the service. Refer-Owl acts as a smart clinical intelligence (CI) partner – validating each response in real time, ensuring the referral meets local criteria, and directing it to the right clinic every time.

Our wise Refer-Owl can also highlight when primary care might want to try alternative treatment before making a referral – as defined by secondary care.

Think of Gateway® and Refer-Owl as your clinical co-pilots, working seamlessly alongside clinicians to make referrals smarter, safer, and smoother for everyone. CI, not AI. 

Play Chess, Not Battleships

We understand that transforming elective recovery through primary care is no simple task – it requires effort, strategy, and collaboration. But like a thoughtful game of Chess, the challenge is worth it. With the right tools and support, GPs and wider primary care can move beyond referral guesswork to make strategic, informed, and confident referrals. This isn’t just about fixing a broken process; it’s about rebuilding trust, boosting efficiency, and safeguarding clinical excellence in a system under immense pressure. Discover how Gateway® can empower your practice and improve outcomes for your patients. The time to act is now.