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Improving access to services through a collaborative learning system at East London NHS Foundation Trust
  1. Amar Shah1,
  2. Auzewell Chitewe2,
  3. Emma Binley2,
  4. Forid Alom2,
  5. James Innes2
  1. 1East London NHS Foundation Trust, London, UK
  2. 2Quality Improvement Team, East London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Amar Shah, East London NHS Foundation Trust, London E1 8DE, UK; amarshah{at}


Early intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and non-attendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT). Fifteen community-based teams across ELFT came together with the shared goal of improving access. These teams were diverse in both nature and geography and included adult community mental health teams, child and adolescent mental health services, secondary care psychological therapy services, memory services, a musculoskeletal physiotherapy service and a sickle cell service. A collaborative learning system was developed to support the teams to come together at regular intervals, share data, test and scale-up ideas through quality improvement and have access to coaching from skilled improvement advisors in the ELFT central quality improvement team. Over the course of the 2-year project, waiting time from referral to first face-to-face appointment reduced from an average of 60.6 days to 46.7 days (a 23% reduction), non-attendance at first face-to-face appointment reduced from an average of 31.7% to an average of 20.5% (a 36% reduction), while referral volume increased from an average of 1021 per month to an average of 1280 per month (a 25% increase).

  • mental health
  • continuous quality improvement
  • control charts/run charts
  • pdsa

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  • Contributors AC and EB designed the project and supported teams through the work. FA supported the measurement, data collection and analysis. JI and AS provided supervision and senior improvement expertise in the design and through the project work. AC and AS led on the submission of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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