Why Secondary Care Backlogs Can’t Be Fixed in Secondary Care

Across the NHS, the instinct is to look at hospitals when discussing backlogs - extra clinics, theatre efficiency, waiting list validation. But the real inefficiency sits upstream.

Thousands of referrals every week could be resolved safely in primary care if clinicians had the right tools to collaborate earlier. And although most ICBs technically have Advice & Guidance in place through eRS, the outcomes tell us it isn’t working as intended.

You can’t fix a communication problem with an administrative platform.

NHS England data shows hundreds of thousands of advice requests now flow through eRS each month, yet the rate of avoided referrals has barely shifted. The volume is there; the impact isn’t.

Why? Because eRS was designed for referrals, not real-time conversation. It’s static, slow, and administratively heavy.

True A&G depends on:

• Rapid two-way dialogue.
• Automated data sharing that minimises GP data entry
• Image sharing with agreed minimum data standards.
• Seamless integration between clinical systems.
• Data that surfaces pathway-level insights in real time.

Those aren’t optional features, they are must have’s that enable Consultants to quickly decide how patients should be managed which transforms the patient’s experience.

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You can’t clear a backlog with forms

A GP might wait days for a reply that should take minutes.
A consultant might review incomplete information or miss the chance to de-escalate a referral.

Multiply that friction across thousands of daily interactions — and inefficiency becomes built into the system itself.

Every extra click, upload, and delay adds pressure to an already stretched service.

That’s why platforms like Cinapsis are designed to remove that friction, enabling real-time communication, integrated data, and automatic documentation, so every advice exchange becomes a clinical resolution, not another administrative task.

Most ICBs don’t need a new digital initiative, they need an upgrade to the infrastructure they already depend on.

An integrated, clinically-led A&G platform delivers:

• Reduced outpatient demand through earlier resolution.
• Higher-quality referrals, supported by structured data sharing.
• Operational insight into variation and demand trends.
• Better clinician experience, driving sustained adoption.

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“We often hear: ‘But we already have A&G through eRS.’ And my response is always: yes, but what you have isn’t designed for the job you’re asking it to do.

eRS was built to move paperwork between care settings. Advice & Guidance is about connecting people. Until those two things align, you’ll keep seeing high administrative load and low impact.

The NHS doesn’t need more technology; it needs technology that reflects how clinicians actually work.”
— Dr Owain Rhys Hughes, CEO & Founder, Cinapsis

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Secondary care backlogs can’t be fixed in secondary care and they won’t be fixed by layering more processes onto outdated systems. The answer lies in enabling clinicians to collaborate at the point of uncertainty, not at the point of referral.

The future of elective recovery isn’t about more throughput, it’s about better communication. And that starts with rethinking what “integration” really means.

Want to see how Cinapsis is helping ICBs move beyond eRS limitations? Get in touch

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