Smiling Female Doctor Looking At Senior Patient

Improving Referral Pathways in the United Kingdom

Case Study:

Helping A Leader in Respiratory Medicine to Improve Referral Pathways in the United Kingdom


The Client

Our client is a world-leader in the development and supply of respiratory medicines, with a strong heritage of providing life-changing therapies to patients who need them.

Their leadership is underlined by their development of an advanced treatment for the treatment of severe respiratory condition and their efforts to improve and accelerate access to patients who need it.


This severe respiratory condition affects ~200,000 people in the UK. Patients diagnosed carry a significantly increased risk of mortality due to their condition.

Often described as ‘difficult to treat’, patients with this condition are diagnosed due to their reliance on rescue therapy despite adherence to routine prescribed treatments, although there is a lack of clarity on a common understanding of a precise disease definition.

Management of this condition in the UK has more recently been transformed by the introduction of advanced treatments which are initiated by specialists in a small number of tertiary care centres.


1,400 people per year die from this respiratory condition in the UK. This makes it critical for patients to be identified, diagnosed and appropriately treated as rapidly as possible. Several barriers to this exist, at present.

The majority of patients are routinely consulting and managed within the primary care setting, usually in general practice. Our client identified the opportunity to address delays to receive optimal treatment that occur with:
Diagnosis not being made due to unclear/misunderstood criteria
Patients ‘lost’ in a loop of referral and discharge between primary & secondary care (not yet reaching tertiary centres)
Time to initiate treatment at tertiary centres may not always be as short as patients may expect



Triducive began working on this project during 2020-2021 and together with the client team, designed a modified Delphi approach which aimed to create:


Our Process

Step 1

A multi-disciplinary group of experts from across the health system were facilitated to pinpoint the challenges to optimal care and then define a set of statements that described ‘ideal’ practice. This steering group was represented by clinical and nursing specialists as well as the main patient group.

Step 2

A structured survey was developed and disseminated across other UK-based specialist HCPs with an interest and expertise in managing this patient group. The survey tested the strength of agreement that existed in relation to all the statements developed.

Step 3

Following structured review of the results by the steering group, a sub-set of the survey statements were then ratified by the patient group and then shared with patients with the condition to further inform statements designed to define realistic but stretching referral standards.

Step 4

A second facilitated review of the full dataset by the steering group led to the development of a core set of recommendations that reflected the results achieved. Recommendations focused on addressing the barriers to effective diagnosis and referral to specialist services for treatment.

Step 5

A manuscript capable of peer-reviewed publication was developed and provided as draft for the steering group to adapt and finalise. Triducive supported the authors to take ownership of the draft and to submit to BMJ for peer review.

Outcomes & Next Steps

Following submission, the manuscript was accepted for publication by BMJ and subsequently published.  The client have since worked with Triducive and other partners to develop a range of campaign activities based on this to drive:

  • Faster identification of patients in primary care for diagnosis
  • Direct referral from primary care to tertiary care, specialist care centres
  • Initiation of advanced treatments in non-specialist centres (where possible)



responses achieved across the HCP & patient community


clear recommendations defining best practice approach and performance standards to achieve effective results across the pathway


Published in a high impact peer-reviewed journal which supports credibility and citation of subsequent materials


Provided a strong platform for the client team to engage with key healthcare agencies to drive changes to national guidelines & programs.

Hear It from An Expert

Watch lead author Dr David Jackson, Consultant Respiratory Physician talk about Triducive’s work:

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