How Cinapsis could solve the NHS’s backlog problem

Dr Owain Rhys Hughes didn’t always want to be a doctor. Growing up in Anglesey, he thought he’d be a scientist. But he played a lot of rugby at school, so naturally he ended up in A&E occasionally. In fact, aged 14, he spent a considerable amount of time in hospital getting patched up, which is when he started thinking about doing medicine himself and cutting out the middleman. Now he is the founder and CEO of Cinapsis, which keeps GPs and consultants in direct contact and cuts down on waiting lists.

There must be a kind of karma at work because as a surgeon he often has to deal with the cauliflower ears and broken noses sustained by rugby players. Hughes studied in Cardiff but spent a year at Harvard in the ear, nose and throat unit. He went on to do stints in Bath and London at Great Ormond Street Hospital and the Royal Marsden, while still playing rugby for Hackney RFC. He rose through the ranks to become a registrar and finally a consultant. But some of his more frustrating experiences inspired him to come up with Cinapsis.

One of his tasks as registrar was to vet referral letters from GPs to specialists asking them to have a look at one patient or another. He had to read through about 200 letters a week. At the end of it all, he realised two things: one was that it was very unlikely he would reject any of the referrals and, secondly, there was not enough information in the letter to enable him to make a determination one way or another. “If only the GP could have spoken to me at the time – or the patient ­– we could have come up with a plan, which might have avoided a lot of trouble.”

Hughes would often end up seeing the patients himself. “I’d be reminded of the letter. The patient is anxious. They have an expectation. They think they need an operation. But often that’s not the case.”

The old system was not really working to the benefit of anyone. The patient would typically have to do a lot of travelling, sometimes in vain. The GP was left to make a decision on their own. And the consultant had the job of separating out the serious from the not-so-serious cases. “It wasn’t direct at all,” says Hughes. “And it was in complete contrast to the junior doctors – they had instant access, we’d have a discussion, and they could manage the patients, with the safety net of further consultation.”

The numbers were huge and a tremendous drain on finite resources – something we are now, post-Covid, more conscious of than ever. With the Cinapsis system, 70 per cent of patients do not ultimately have to be seen in hospital and their cases are resolved through advice and conversation. At last the “consultant” really can be consulted. There is nothing wrong with a good old-fashioned letter, often written with pen and ink, but it is a bit clunky and probably not the most efficient means of communication between a GP and a consultant. A Cinapsis “SmartReferral” app on your phone can digitise and speed up the whole process.

“We’ve made it easier for GPs to seek advice,” says Hughes. “It can often be resolved then and there. From the hospital point of view we can decide when we are going to see you, with what degree of urgency.” Under the old system of referrals, suspected cancer cases can be sent to the “Two Week Wait Clinic”, but the chances are only between one in 10 and one in 20 that the patient will be taken further. Using Cinapsis, the consultant can make a decision on the basis of photos. “It’s not just a binary decision, to see someone or not. They can be stratified if we see it’s another problem.”

There are only so many dermatologists to go round. The same thing with paediatricians and A&E specialists. Often a GP will take a quick look at a patient and then send them off to A&E. Cinapsis provides an alternative approach. “It used to be you didn’t know anything about the patient before they walked through the door. Rather than send someone over the doctor can now call up and have a conversation with the specialist. That way you can schedule it and convert emergency care into planned urgent care. By understanding what the problem is to begin with it works better for the trust and it’s more convenient for the patient. They don’t waste hours hanging about.”

Hughes gives the example of a patient diagnosed with breast cancer who goes to see her GP because of shortness of breath. Could it be a pulmonary embolism? The GP isn’t sure. To be on the safe side the patient will be sent to A&E, and might get scanned the next day. “With Cinapsis there is no waiting. I can give advice to start anti-coagulation treatment right now and arrange for a scan on the following day.”

Cinapsis isn’t a start-up anymore. Its software has been tried and tested over a period of years. “It all took time,” says Hughes. “Moving patient information around the system has to be robust. There is clinical safety to think about and data sensitivity.” But the biggest problem they ran into was a degree of scepticism. Why would consultants want to spend time doing this, they asked.

They’re not asking it now though. Cinapsis is working with 16 trusts across the UK, in Cambridge and Liverpool and Bristol and beyond. “It allows consultants to deal efficiently with patients who don’t need face-to-face. And you have more time for the patients who do need it.”

According to a recent statement from Sajid Javid, the current NHS waiting list is around five million – and projected to go up as high as 13 million. When referral letters have gone out those patients will have to be seen. But among those patients are some who don’t need to be seen. And then some who absolutely do, with potentially devastating consequences if they’re not. But critical cases can get held up in the queue. Cinapsis is helping to reduce the backlog.

Owain Rhys Hughes is not a fan of the term “triage”. “It’s a cold word,” he says. He doesn’t see Cinapsis as a triage system. “It’s about providing support. Doctors can share knowledge. Hopefully we are more coordinated and cooperative. And it will make our lives a bit easier.”

@andymartinink