A pilot in northern Lincolnshire has cut hospital referrals for rheumatology patients by three quarters by placing a specialist consultant on a video call at the end of a GP clinic. No new buildings, no new equipment, and no requirement for patients to travel to a hospital. The model is now being studied at a national level by NHS England's Getting It Right First Time programme.

The scheme operates under the Connected Health Network model at Northern Lincolnshire and Goole NHS Foundation Trust. In practice, a GP with a special interest in rheumatology and dermatology sees and triages patients at a primary care clinic. Towards the end of the session, a lead rheumatology consultant joins remotely by video call to review cases, advise on appropriate investigations, guide management decisions and determine whether a hospital referral is actually warranted. Patients who need additional support can access physiotherapy, weight management programmes, social prescribing and mental health services directly through the same pathway, without a separate outpatient appointment.

The service currently accepts around 200 new patients per year. Referrals come from GPs and physiotherapists, and the clinic also picks up patients who would otherwise have remained under secondary care management indefinitely. The 75 per cent reduction in referrals from Meridian PCN to hospital is the figure that has attracted external attention, and it is significant enough to prompt questions about why the approach is not more widespread. The pilot's inclusion in the Getting It Right First Time workspace on the NHS Futures collaboration platform represents formal recognition that the model is worth examining beyond its original geography.

The referral numbers are not the whole story. Doria Bouzebra, who led the project from Meridian PCN alongside Northern Lincolnshire and Goole consultant rheumatologist Tim Gillott, said the pilot had met its initial clinical objectives as well as its operational ones. "In addition to helping reduce secondary care waiting lists, we've achieved our initial aims of eliminating addictive drug prescribing and implementing a robust, community fibromyalgia pathway that keeps patients out of hospital settings, while providing more holistic and effective management of their condition," she said. Fibromyalgia is a chronic pain condition that has historically been difficult to manage well in primary care, often resulting in repeated secondary care referrals with limited clinical benefit. Having a structured community pathway changes that dynamic.

For patients, the difference is straightforward. Alex Afifi, senior project manager for patient services at the trust, described the model as a neighbourhood and community interface service built on collaborative multidisciplinary working. "Patients don't have to attend the hospital, so it's less stressful for the patient and they're seen quicker," he said. "Primary care also have access to a much wider range of support services which we don't have in secondary care." That last point matters. The model does not simply redirect patients; it gives primary care teams clinical tools and specialist oversight they would not otherwise have access to.

The wider significance is difficult to ignore given where the NHS currently sits with elective care. Secondary care waiting lists remain a central pressure point across the health service, and much of the policy debate has focused on increasing hospital capacity or reducing treatment times. This pilot points to a different question: how many patients on those waiting lists actually need to be there? Where specialist input can be brought into a GP setting by video, some of the demand that currently flows into secondary care may not need to reach it at all.

The model requires a willing consultant, a GP with relevant specialist interest, and a video connection. It does not require a new facility or significant capital investment. That simplicity is either an argument for rapid replication or a reason to ask why it has taken this long. The NHS now has at least one set of numbers to work with.