Medefer in partnership with Barking, Havering and Redbridge CCGs to test the virtual hospital model of care to reduce gastroenterology backlogs and consultant capacity challenges.

Context

In 2016, Medefer was commissioned by the former Barking, Havering and Redbridge Clinical Commissioning Groups (CCGs) to test a new “Virtual Hospital” model of care designed to support local gastroenterology services facing significant backlogs and consultant capacity challenges.

Medefer worked to support Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), the main acute provider for the area, by introducing a consultant-led virtual outpatient model to deliver rapid triage, clinical review and remote management for patients referred by GPs. The aim was to reduce waiting times, improve access and make better use of diagnostic capacity across the local system.

As part of the pilot, local GP practices were able to refer directly to Medefer through agreed pathways, while approximately 1,000 long-waiting patients were transferred from the BHRUT backlog for virtual assessment and management. This dual approach allowed Medefer to support both existing long-waiting patients and new GP referral activity, ensuring equity of access across the local population.

Following the success of this initial phase, which delivered measurable backlog reduction, faster access and positive patient outcomes, the model was adopted and expanded into a Single Point of Access for all gastroenterology and hepatology referrals across Barking, Havering and Redbridge.

The service covered around 120 GP practices and a population of one million, and was later managed under the North East London Integrated Care Board following CCG integration. Medefer’s Virtual Hospital concept, first presented to and developed with commissioners, became a recognised example of digital innovation in outpatient transformation and elective recovery.

Approach

Single Point of Access for all gastroenterology and hepatology referrals from GP practices across the Trust areas, serving a population of approximately one million.
Remote-first, consultant-led model with all referrals clinically triaged and managed virtually where safe and appropriate.
Coordinated diagnostic capacity across BHRUT and partner independent diagnostic providers, allowing efficient use of multiple diagnostic sites across the area.
Structured clinical risk assessment ensuring safe prioritisation and effective capacity planning for in-person care.
Onward referrals to BHRUT managed through the NHS e-Referral System (e-RS), ensuring smooth access to hospital-based pathways when required.
Full RTT and SUS reporting delivered by Medefer to support accurate performance monitoring and compliance.
Collaborative clinical governance aligning Medefer’s consultant network with local NHS teams under ICB oversight.

Outcomes and impact

Significant reduction in outpatient demand, supporting BHRUT to maintain RTT compliance without the need for insourcing or external clinical support.
Freed consultant capacity, enabling the Trust to expand its in-house endoscopy provision from three to five rooms.
BHRUT became recognised as one of the top three JAG-accredited endoscopy units nationally.
IBD hot clinics were established using consultant time released through the virtual hospital model, improving access and reducing A&E attendances.
Coordinated diagnostics across BHRUT and independent sector providers supported timely investigation and continuity of care.
Sustained RTT performance, positioning BHRUT as a top performer nationally in gastroenterology access and elective recovery.

Recognition and awards

The work undertaken in Barking, Havering and Redbridge has been widely recognised for its innovation, system impact and contribution to elective recovery.

2023 HSJ Partnership Awards. Winner: Best Healthcare Provider Partnership with the NHS

2024 Health Business Awards. Silver Award: Environmental Sustainability Project of the Year

2024 HSJ Awards. Finalist: Long-Term Partnership with the NHS

In 2025, Medefer’s work in Barking, Havering and Redbridge was featured in NHS Online and the Health Service Journal coverage of the Prime Minister’s announcement of the forthcoming ‘Online Hospital’ initiative, identifying the BHR Virtual Hospital as a proven example of consultant-led, digitally enabled elective care supporting the NHS Long-Term Plan and elective recovery priorities.

Strategic takeaway

Medefer’s work across Barking, Havering and Redbridge demonstrated how a digitally enabled, consultant-led model can safely and effectively transform outpatient pathways and strengthen local system capacity.

Initially commissioned to pilot a new Virtual Hospital model, the programme evolved into an award-winning, comprehensive Single Point of Access service, enabling rapid consultant-led triage, streamlined diagnostics and sustained RTT compliance for gastroenterology and hepatology patients across North East London.