Medefer working with James Paget University Hospital (JPUH) and the Norfolk & Waveney Integrated Care System to reduce backlogs in gastroenterology and hepatology.

The James Paget University Hospital (JPUH) and the Norfolk & Waveney Integrated Care System (ICS) faced significant backlogs in gastroenterology and hepatology, driven by limited consultant capacity and rising demand. Medefer partnered with the ICS and JPUH under an existing Any Qualified Provider (AQP) contract to deliver a remote-first, consultant-led service designed to:

Reduce long waits
Free local consultant time
Improve patient access.

Approach

Inter-Provider Transfer (IPT) of approximately 1,000 long-waiting patients from the JPUH backlog
Remote-first, consultant-led model, with all clinical management decisions made by consultants
Coordinated diagnostics jointly with JPUH, and where needed local Medefer partner providers, to add capacity within the local system
Risk-based clinical assessment model (Red/Amber/Green) supporting effective prioritisation and utilisation of JPUH diagnostic and in-person capacity, ensuring clinical safety and optimal use of local resources
Medefer responsible for all national reporting requirements (SUS, RTT, DM01).

Backlog results

945 patients transferred from the JPUH waiting list
86% of backlog patients discharged without requiring an in-person hospital appointment
Average 6.2 days from referral to first consultant assessment, 46% of backlog patients reviewed within 48 hours of transfer
4.4% upgraded to the Urgent Suspected Cancer (USC) pathway; 1 patient appropriately escalated to A&E.

Benefits to JPUH & ICS

Rapid backlog reduction and recovery toward RTT compliance
Freed local consultant capacity, allowing hospital specialists to focus on urgent and complex in-person cases
Free local management capacity from managing backlog and focus on service improvement instead
Maintained clinical safety through structured risk assessment and escalation processes
Strengthened collaboration between Medefer, JPUH and local diagnostic providers

New referral service delivery

Alongside backlog clearance, Medefer published its AQP Gastroenterology service on the e-Referral system.

Performance highlights

67 new referrals received during the project period
0.6 days (≈14 hours) average time to first consultant review
92.6% of new referrals reviewed within 48 hours; 20% within 1 hour
83% of new referrals care completed remotely with no hospital OPD visit required
Remaining cases: 12 referred to JPUH (3 upgraded to the 2-Week Wait pathway); 4 discharged due to patient choice or non-attendance.

These outcomes confirm that Medefer’s remote-first model is both rapid and safe, providing a sustainable, scalable pathway for managing ongoing elective demand.

Future partnership and expansion

Building on the project’s success, after Medefer’s contract with the ICB, JPUH has commissioned an ongoing subcontract with Medefer to sustain elective recovery and strengthen system capacity.

80 referrals per month will continue to be redirected from the Trust to Medefer
The partnership will add local resilience and capacity, helping to reduce demand, improve access and support prioritisation of cases requiring in-person specialist care
Medefer and JPUH are in discussion to extend specialist support, further expanding consultant reach across the region. Cardiology and Neurology have been identified by JPUH as priority specialties for further collaboration.

Strategic takeaway

This partnership demonstrates a flexible, multi-specialty solution that adds sustainable clinical capacity across the system. By integrating remote consultant expertise with local diagnostics, Medefer enables ICS partners to reduce demand, improve access and prioritise patients who need in-person specialist care. The model is scalable across multiple specialties, offering a proven framework for system resilience and elective-care recovery.