A single point of access should not be just a front door, it should be part of a pathway redesign strategy.
By Dr Tom Oakley, CEO, Feedback Medical
The NHS is investing significant effort into implementing elective single points of access (SPoAs). As systems work towards national SPoA requirements, there is a risk that organisations focus primarily on creating a new referral gateway rather than redesigning the pathway that sits behind it. The result is often a digitally enabled queue rather than a transformed service.
If SPoAs are to deliver meaningful reductions in waiting times, improved productivity and better patient experience, they must be viewed as a pathway redesign programme, not an administrative function.
The organisations achieving the greatest impact are not simply changing how referrals enter the system. They are redesigning elective pathways around earlier clinical decision-making, earlier access to diagnostics and more effective multi-disciplinary collaboration. Our work on pathway transformation has demonstrated more than 90% fewer outpatient appointments across multiple pathways and around 8.7 weeks average pathway length with 100% completed within 18 weeks.
The principles of this approach are outlined in Feedback Medical’s Pathway Redesign Playbook, which argues that the future of elective care depends on designing pathways around decisions rather than appointments.
Transform pathways first
As NHS organisations develop SPoA models, the playbook argues that success will depend on more than centralising referrals. Many existing SPoAs provide a common access route before directing patients to another specialty-specific waiting list. While this may standardise referral management, it does little to address delays between referral, investigation and diagnosis.
Systems should instead redesign specialty pathways around the earliest safe clinical decision. This means moving away from the traditional sequence of “Referral → Specialty → Appointment” towards:
Referral → Information Gathering → Diagnostics → Clinical Decision → Appropriate Care Setting
Under this model, referrals lead to the information, testing and specialist input needed for a decision rather than automatically triggering an outpatient appointment. Patients are routed to the most appropriate care setting only once that decision has been reached.
What pathway transformation requires
In practice, this requires structured clinical information and patient questionnaires to be gathered before specialist review, with straight-to-test and bundled diagnostics introduced where appropriate. Asynchronous specialist and multi-disciplinary review can support earlier decisions without defaulting to a first outpatient appointment, while clear clinical criteria can guide onward care, discharge or escalation across providers.
Progress should be measured through time to diagnosis and decision, avoided appointments and appropriate discharge; not activity alone. Shared digital workflows, pathway visibility and cross-organisational collaboration are also essential to ensure information can move efficiently between primary care, diagnostics, specialties and providers.
Evidence from redesigned pathways
The value of this approach is already being demonstrated in practice.
For example, Queen Victoria Hospital NHS Foundation Trust’s digitally enabled insomnia pathway gathers patient questionnaires, sleep diaries and triage information before specialist review. Early pilot data showed that 36% of patients could be discharged with a management plan, 28% were directed to home diagnostic testing, and 36% were referred into specialist sleep services due to alternative diagnoses.
Patients were able to access specialist advice within as little as three weeks compared with traditional waits of up to 20-25 weeks.[1]
When pathways are redesigned around information, diagnostics and decision-making, patients reach the right outcome faster, while clinicians can focus their time where it adds the greatest value.
The future of elective care
NHS England’s SPoA programme represents an important opportunity to rethink how elective care is delivered. But success will not be measured by how many referrals flow through a single gateway.
It will be measured by whether patients receive faster diagnoses, quicker treatment decisions and more streamlined care.
For NHS trusts and ICBs implementing SPoAs, the key question is therefore not: “How do we create a single point of access?” It is: “How do we redesign the pathway behind it?”
The organisations that answer that question successfully will create SPoAs that do more than manage demand. They will build a new model of elective care that is faster, more productive and better aligned to the needs of both patients and clinicians.
You can read the Pathway Redesign Playbook and summary version here.
[1] Feedback Medical. (2026). Pathway Redesign Playbook: Leveraging Diagnostics to Drive Elective Transformation. Available at: https://feedbackmedical.com/service-areas/diagnostic-enhanced-advice-and-guidance/pathway-redesign-playbook/
