NHS England announced this month that its elective, emergency care and mental health improvement support teams are being merged under the Getting it Right First Time (GIRFT) programme. This consolidation of around 70 improvement specialists under clinical leadership signals a clear strategic direction: standardisation and variation reduction will drive NHS transformation.
The paradox of record activity and rising waits
The timing is telling. NHS England reports record elective activity over summer 2025, with 4.6 million cases managed between June and August – up 138,000 on the previous year. Yet waiting lists rose for the third consecutive month, reaching 7.41 million in August.
The message is clear: working harder isn't enough. The NHS needs to work smarter. This is precisely where the GIRFT methodology excels – confronting variations in how services are delivered, sharing best practice between trusts, and identifying changes that improve care whilst delivering efficiencies.
Where variation starts: the referral point
Healthcare variation often begins at the very start of the patient journey. Traditional referral processes create the unwarranted variation that GIRFT seeks to eliminate through inconsistent information requirements across trusts, complex criteria that vary between providers, and differing interpretations of clinical guidelines.
The result? Patients with identical clinical presentations receive different treatment depending on which practice submits their referral. This isn't just inefficient – it's inequitable.
GIRFT principles meet the 10-Year Health Plan
The NHS 10-Year Health Plan emphasises that digital tools must "expose variation in care through greater transparency, supporting more equal adoption of best practice." The plan commits to ensuring that "once an innovation has been robustly assessed by one NHS organisation, further NHS organisations will not be able to insist on repeated assessments."
This perfectly describes what standardised referral processes achieve. The government's commitment to "at least 3% of the budget for service transformation investments" means proven productivity solutions like standardised referral systems qualify for strategic investment.
SMART referrals: standardisation in practice
At DXS, our approach embodies the GIRFT methodology of standardisation and variation reduction. Our SMART referral forms demonstrate how eliminating process variation translates directly into improved outcomes.
At East Suffolk and North Essex NHS Foundation Trust, implementing standardised SMART referral forms eliminated inappropriate referrals entirely – from 36% to 0%. Crucially, this improvement was consistent across all referring practices, regardless of their patient demographics or historical patterns. Waiting times were halved from 44+ weeks to 22 weeks, demonstrating that when referral processes are properly standardised, both efficiency and access improve simultaneously.
Similar improvements have been documented across multiple specialities, including MSK, cardiology, gastroenterology, and mental health services. The consistent factor? Standardisation of referral requirements, clinical decision support, and information capture.
How we deliver standardisation
Mandatory fields functionality ensures every referral contains essential information, eliminating the process variation that leads to rejections and delays. When every GP captures the same core data elements, secondary care teams receive consistent, high-quality referrals regardless of source.
SMART Assist with links to NICE guidance provides standardised clinical decision support at the point of referral, ensuring all GPs have access to the same evidence-based guidance regardless of location or experience.
Patient validation logic provides intelligent checking that catches process errors early, preventing administrative back-and-forth that creates variation and delay.
Clinical calculations ensure accuracy regardless of practitioner experience, whilst show and hide functionality means forms adapt intelligently to clinical selections.
Zero digital bias ensures that the same clinical presentation generates the same referral outcome, regardless of which practice submits it – directly addressing the equity concerns that GIRFT methodology seeks to resolve.
What the GIRFT consolidation means
For NHS trusts and ICBs working to deliver elective recovery whilst managing financial constraints, the GIRFT consolidation offers a clear framework: focus on standardisation, eliminate unwarranted variation, and adopt proven best practices systematically.
The 10-Year Health Plan's "innovator passport" – where robust assessment by one NHS organisation prevents others insisting on repeated assessments – should accelerate adoption of proven solutions. For referral management, this means organisations can have confidence in solutions that have already demonstrated measurable improvements elsewhere in the NHS.
Referral management sits at the heart of elective recovery. Every inappropriate referral wastes specialist capacity that could have been used for patients who genuinely need it. Every delayed or rejected referral extends waiting times for patients already in distress. Every administrative query consumes time that clinicians could spend on patient care.
The question for healthcare leaders
As NHS England consolidates its improvement functions under GIRFT leadership, the message is clear: standardisation, variation reduction, and systematic adoption of best practice will drive sustainable elective recovery. This isn't about working harder – NHS staff are already delivering record activity levels. It's about working smarter, ensuring that every referral, pathway, and clinical interaction is optimised.
For organisations serious about elective recovery, the question isn't whether to embrace standardisation – it's how quickly you can implement it. Every day that referral processes remain variable is another day that patients experience inequitable access, clinicians waste time on preventable administration, and specialist capacity is consumed by inappropriate referrals.
The technology to enable systematic standardisation exists today. The evidence of its impact is documented and independently verified. The strategic direction from NHS England supports its adoption.
What's needed now is leadership willing to embrace proven solutions rather than accepting that variation is inevitable.
David & the DXS Team
Want to discuss how SMART referrals can support equitable access in your organisation? Get in touch – hello@dxs-systems.co.uk.
