Returning 2,144 clinical hours to the NCL CKD team and processing 4,289 referrals through end-to-end automation
| Outcomes at a glance |
|---|
| Outcomes |
| • 2,144 hours (286 working days) returned to the CKD team, at 30 minutes saved per referral |
| • Winner: Quality Improvement and Efficiency, RFL Staff Awards 2024 |
| • DPIA completed and DCB0160 clinical safety standard achieved before go-live, ensuring clinically safe, governance-approved automation at NCL-wide scale |
| Reach and delivery |
| • 4,289 CKD referrals processed end-to-end between go-live in April 2024 and March 2026 |
The challenge
Chronic kidney disease (CKD) is a long-term condition affecting around one in ten people. There is no cure for CKD, but early diagnosis and treatment can help to relieve symptoms and prevent further deterioration. Left untreated, advanced CKD (stage 5) can require dialysis or a kidney transplant.
North Central London’s CKD service receives between 50 and 70 referrals each week. Before automation, each required around 30 minutes of manual processing: registration onto the EMIS clinical system, triage preparation, and outcome letter creation. Beyond the resource cost, the manual process carried clinical risk. Transcription errors, registration delays, and reduced clinician access to records at the point of triage all constrained the team’s capacity to deliver timely, accurate care. Competing demands on administrative staff meant a significant portion of the team’s time was taken up with processing, reducing capacity for other essential work.
Our approach
TPHC’s Digital Productivity team worked with the service to design and deploy an automated referral workflow, integrating NHS e-Referral Service with EMIS to manage the full CKD referral pathway. The automation enables clinical teams to access patients’ primary care records securely via EMIS during triage. The three stages of the automated pathway are:
| Registration | Triage | Discharge |
|---|---|---|
| New referrals collected from NHS e-Referral Service and registered onto EMIS, with secure access to primary care records enabled for triage. | Outcome letter generated for the referring clinician using comments entered via EMIS, keeping them informed and enabling follow-up action. | Completion of the triage process marked in EMIS, discharging the patient and closing the referral pathway. |
The team led the governance work required to operate safely at scale. A Data Protection Impact Assessment and compliance with the DCB0160 clinical safety standard were both completed before go-live, reflecting the sensitivity of the patient information being handled and transferred daily. This approach gave all stakeholders confidence that the automation was sustainable, safe, and compliant. The automation has run continuously since April 2024.
The impact
Automating registration and enabling EMIS access to primary care records during triage supports more accurate, evidence-based clinical decisions. Patients receive a faster, more consistent referral pathway with less risk of delays or errors from manual handling.
Since go-live in April 2024, the automation has processed 4,289 CKD referrals end-to-end to March 2026. At 30 minutes saved per referral, this represents 2,144 hours (286 working days) returned to the CKD team over that period. Administrative staff are freed from manual processing, creating capacity for work that requires clinical judgement. The project won the Quality Improvement and Efficiency award at the RFL Staff Awards 2024.
Having met the DCB0160 standard and completed a full DPIA, the model demonstrates that clinically safe, governance-approved automation can operate reliably at NCL-wide scale. Well-documented and transferable, it offers a reference point for other specialities considering comparable automation across NCL or beyond.
What our clients say
“The TPHC Digital Productivity team worked closely with us to design and deliver this innovative solution to support interoperability between two clinical systems, facilitating a comprehensive triage process at scale across NCL. Simultaneously, it has reduced the manual burden on administrative teams, freeing them up to deliver essential workload. It has been a pleasure to work with the TPHC team, who have been collaborative and responsive throughout the project.”
Sarah Milne, Clinical Lead for Chronic Kidney Disease, Royal Free London NHS Foundation Trust
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