Choose & Book Michael Thick National Medical Director for CaB and PACS 12 th May 2005

Introduction One part of the bigger picture Current view of booking and choice! How are we doing?

NHS Connecting for Health facilitate all clinical activity electronically ICRS- integrated care record service eTP - electronic transfer of prescription PACS - picture archiving & communication system access to records anywhere in the country CAB – choose and book

NHSCfH Programme Electronic Booking December 2005 ETP 50% national implementation December 2005 – 100% December 2007 ICRS phase 1 December 2004 – phase 2 December 2006 PACS 1 / 3 roll out by December 2004 – complete December 2006 Infrastructure full connectivity March 2005 (N 3 )

Electronic booking components Electronic Booking Service (EBS) CAB Software (Atos) Directory of services (DoS) Bookings Management Service (BMS)

EBS Objectives Patient choice convenient date time & place for appointments and admissions ensure services are designed around patients use IT to improve convenience the patient is an essential partner

Patient requests: 42% would like to choose appt. date and time 46% would like choice of treatments 31% would like choice in the service the can use 31% would like choice of hospital 31% would like choice of doctor MORI (Oct-Nov 2003) Choice, Responsiveness and Equity National Consultation

Electronic Booking Service The patient can choose place of treatment/investigation make a booking (have referral documents sent) By a range of electronic channels direct on-line booking telephone contact centres/BMS internet and digital TV

Booking Management Service (BMS) additional channel to facilitate e-booking patients can make booking at own convenience supports patients and professionals amending and cancelling appointments supports patients exercising choice

BMS scope make a booking also change, track and cancel bookings facilitate choice of date time location (directory of services) first outpatient appointment

Directory of services (DoS) available services booking guidance/protocols visible appointment slots selectable by specialty team name gender distance linked to NHS.uk

GP/patient Primary care system Consultant/patient CAB InternetBMS PAS system Available appt. slots Booked appt. slots Directory of services Provider info PCT Commissioning rules Appt. reminders DNA queries Referral letter Advice & guidance Choose and Book

Electronic booking is a tool Support and improve patient choice Help reduce waiting times Facilitate patient pathway reform Safety - clinical governance Convenience – a fully booked NHS

A tool is only useful if you know what it is and how to use it…

Advantages no lost referral letters legible letters fewer steps from decision to refer to patient attendance choice at the point of referral a new service - Advice and Guidance

Advantages better care for all if templates/protocols are followed patients appropriately worked up in advance Xrays and bloods etc

Managerial advantages a full audit trail is available no lost referral letters fewer cancelled appointments

Concerns GPs historic practice lack of interest in IT perceived lack of time belief that this will all go away

Concerns Hospital Consultants no control over referral referral to other services or hospitals belief that this will all go away Clerical staff redundant cancellations follow-up appointments

Conclusion Choose & Book is here to stay we all need to be prepared Booking the engine which delivers patient choice

Clinical input vital to set up referral trees to set up DoS to avoid inappropriate referrals sell our services be ready for PBR, practice based commissioning Conclusion

DoS Speciality Clinic Type Service Orthopaedic surgery Upper limb shoulderselbows

DoS Recommended service naming: Service nameMandatory Department nameMandatory Provider organisation nameMandatory Provider NACs codeMandatory

Information held about a Service Service name (nationally unique) Keywords Workgroups for access control Lead professional (optional) Specialty Clinic Type(s) Effective Date Advice & Guidance Service Specific Booking Guidance Referral letter lead time Referral letter freeze time Slot harvesting time span Staffing gender

A specialty is a treatment function A clinic type is a sub- categorisation of a specialty (nationally defined) Specialty General Surgery 100 Urology 101 General Surgery Minor Surgery Upper GI Lumps and Bumps General Urology Urodynamics Haematuria Fast Track Clinic Type Colorectal Surgery 104 Vascular Surgery 107 Colonoscopy Colorectal General Rectal Flexi Sigmoidoscopy General Vascular Doppler Test

General SurgeryMinor SurgeryUpper GILumps & Bumps General Surgery St Anns Upper GI St Anns General Surgery St Anns Lumps & Bumps St Anns Minor Surgery Specialty Services Appt slots Clinic Types An example service structure …

How services are structured may vary … General Surgery St Anns Upper GI St Anns General Surgery St Anns Lumps & Bumps St Anns Minor Surgery General Surgery Kings Lumps & Bumps Kings General Surgery Kings Upper GI General + Minor General Surgery Specialty Clinic Types Services Appt slots

What are my Services? A Simple Example Just three clinics run by three consultants Mr Brown specialises in Arms but sees general cases too; Mr Green does Legs and general cases; Mr White does Heads and general cases One service would mean that Mr White might get Arm cases Six services but general case has arbitrary choice to make Four services Arms; Legs; Heads; General (pooled) Arms, Legs and Heads may be Clinic Types but if not use Service name; Service Specific Guidance; Keywords etc to channel referrals General Arms Mr B General Legs Mr G General Heads Mr W

……so how are we doing?!

247 Days Left 743 Live bookings to date (as at 9/05/05) Bookings per LHC First Booking Date 332 Barnsley 28 Jul Haringey 02 Jul Croydon 25 Jan Harrogate 11 Feb N Derbyshire30 Sep Chesterfield 06 April Enfield 05 April 05 4 North Surrey 24 Jan 05 4 Islington 14 April 05 Kingston

Update since last meeting Key Delivery Challenges: 1.Reforming patient pathways: diagnostic, surgical/medical, pre-referral 2.Measuring performance: accurately capturing the whole patient journey 3.Tailored support: establishing a credible NHS support model 4.Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning Key Delivery Challenges: 1.Reforming patient pathways: diagnostic, surgical/medical, pre-referral 2.Measuring performance: accurately capturing the whole patient journey 3.Tailored support: establishing a credible NHS support model 4.Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning Major Milestones: a)Complete initial assessment (Jun 05) b)Complete national delivery plan (Dec 05) c)Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06) Major Milestones: a)Complete initial assessment (Jun 05) b)Complete national delivery plan (Dec 05) c)Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06) Number of bookings increased from 480 to 743 since 13th April Practices55 Specialties49 New PCTs 3 5 new sites due to go live in May 19 out of 28 SHA returns Development of programme and support model Number of bookings increased from 480 to 743 since 13th April Practices55 Specialties49 New PCTs 3 5 new sites due to go live in May 19 out of 28 SHA returns Development of programme and support model

Choose and Book Implementation Choose and Book Programme Assurance of Choice Assurance of Choice IT Roll-Out Performance Management Performance Management Proof of Concept Proof of Concept Comms &StkH. management Programme Management Service Implementation

Proof of concept – organising around key elements of delivery Proof of Concept Strategic plan development Existing system supplier co- ordination Secondary care (capacity) project plan management Primary care (capacity) project plan management Snag list management Helping the programme and SHAs focus energy, to ensure all are working toward the same vision and targets. Monitoring and assessing impacts of policy changes and communicating changes. Helping the programme and SHAs focus energy, to ensure all are working toward the same vision and targets. Monitoring and assessing impacts of policy changes and communicating changes. Central repository of outstanding snags and showstoppers. Working in partnership with Connecting for Health, DH and SHAs; monitoring and reporting on the effectiveness and speed of resolution; prioritising; and escalating. Working in partnership with Connecting for Health, DH and SHAs; identifying, prioritising and resolving support gaps; and escalating roll out problems for resolution. Working in partnership with Connecting for Health, DH and SHAs; monitoring and reporting on implementation timeframes; and escalating issues for resolution.

Proof of Concept Performance management Weekly performance management and in-depth analysis of problems to target resources Planning & project management Establish project governance structures, roles and responsibilities and targets Technology troubleshooting Establish process for problem identification, escalation and resolution NED engagement Making Choose and Book a priority Benefits realisation Identify potential benefits and realise through implementation GPs live Agreeing a joint PCT/GP practice plan Specialities live Agreeing a speciality roll out plan Patient focused communication Increase demand for the Choose and Book service Focus areas

IT Roll-Out Existing System Suppliers Technical Support to Implementation Patient Access Patient Access Registration Authority Development Deployment frameworks agreed with McKesson, iSoft, Seetec and IPS Release 2 remains on target for delivery late Spring 2005 Registration processes Rolled out Registration processes Rolled out Registration kit in place BMS and patient information

Service implementation Service Implementation Stakeholder Management Stakeholder Management Implementation Toolkit Implementation Toolkit Implementation Programme Site Support Site Support Implementation Strategy Implementation Strategy Performance Management Performance Management SHA mobilisation support Additional support to LHCs SHA mobilisation support Additional support to LHCs Co-ordination of IT roll-out and delivery of service change Developing a user friendly set of materials to support the service in implementation Encouraging organisational support

Service implementation support Centrally based, flexible support team with expertise and influence directed to enhance local skill and confidence and focus on risk areas SHAs PCT MH Trust MH Trust NHS Trust NHS Trust IS Provider Support SHA Mobilisation SHA strategic/cluster delivery Support SHA Mobilisation SHA strategic/cluster delivery Direct Support Site specific, additional support Direct Support Site specific, additional support LHC and GDPs

Support process Ongoing Performance Management PlanningMobilisation Ongoing Support Additional Support

Planning Increase organisational support Co-ordinate IT delivery and service change Myth busting Directory of Guidance Technical steps Clarifying Choice assurance Outpatient scheduling

Mobilisation SHAs PCT MH Trust MH Trust NHS Trust NHS Trust IS Provider LHC GDPs Mobilisation support at SHA level to maximise roll- out Targeted support at high risk LHCs Supported by centrally based team, aligned to geographical areas, with expertise and influence directed to enhance local skill and confidence and focus on risk areas.

Access to help when things dont work Ongoing support from central team Performance management Recognition of achievement Gather good practice Availability of support Ongoing Support

Additional Support SHAs PCT MH Trust MH Trust NHS Trust NHS Trust IS Provider LHC GDPs SHA monitors and reports performance –central support available to SHAs Targeted support at high risk LHCs Nature of additional support post-mobilisation to be informed by lessons learnt from roll-out. Supported by centrally based team, aligned to geographical areas. Stage 5 Ongoing Perf Mgmt Stage 1 Analysis Stage 2 Diagnostic Stage 3 Planning Stage 4 Implementation Stage 5 Ongoing Perf Mgmt Stage 1 Agree nature of Support Stage 2 Stage 3 Planning Stage 4 Implementation Engagement and diagnosis

Roll-out support functions Connecting for Health Connecting for Health Supplier SHAs Clusters RMU PCTs Acute trusts GP Practices GP Practices National Service Helpdesk National Service Helpdesk Intervention Team Intervention Team Central planning and co- ordination of support deployment in each cluster Accountable to Cluster Board Support: Technical support to PCTs/trust/GPs during roll-out Planning:Collate all PCT plans and update SWIP Central planning and co- ordination of support deployment in each cluster Accountable to Cluster Board Support: Technical support to PCTs/trust/GPs during roll-out Planning:Collate all PCT plans and update SWIP Cluster Deployment Planning Group Deployment of available resources Escalation to Connecting for Health/SHA/Supplier Cluster Deployment Planning Group Deployment of available resources Escalation to Connecting for Health/SHA/Supplier Supplier Account Management Supplier Account Management Supplier Area Management Supplier Area Management Mobilisation and co-ordination of support Establishing Healthcare framework Negotiating fees with ESPs Part of NPfIT Mobilisation and co-ordination of support Establishing Healthcare framework Negotiating fees with ESPs Part of NPfIT Will resolve technical issues or forward to NSD NPfIT Interfaces with Supplier helpdesks NPfIT Interfaces with Supplier helpdesks

Existing Delivery Support Resource technical project management training central support Existing Delivery Support Resource technical project management training central support Connecting for Health Connecting for Health Supplier SHAs Clusters RMU PCTs Acute trusts GP Practices GP Practices National Service Helpdesk National Service Helpdesk Intervention Team Intervention Team BIM RMU tech support LBCs Existing Systems & Suppliers Lead Exec Leads C&B PM National trainers Local trainers Clinical Leads Supplier Account Management Supplier Account Management Supplier Area Management Supplier Area Management Supplier Area Mgr Supplier Account Mgr C&B PM

Assurance of Choice Assurance of Choice Assurance and Monitoring Commissioning Public Awareness Public Awareness Information Provision Information Provision Implementing Choice Implementing Choice

Performance Management Performance Management Performance Management Performance Management Incentives Reporting template completed Utilisation measure finalised and communicated through STEIS webpage First data return (May) due in June Reporting template completed Utilisation measure finalised and communicated through STEIS webpage First data return (May) due in June Final clarification for stage 1 incentive scheme issued end of May

Next steps Key Delivery Challenges: 1.Reforming patient pathways: diagnostic, surgical/medical, pre-referral 2.Measuring performance: accurately capturing the whole patient journey 3.Tailored support: establishing a credible NHS support model 4.Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning Key Delivery Challenges: 1.Reforming patient pathways: diagnostic, surgical/medical, pre-referral 2.Measuring performance: accurately capturing the whole patient journey 3.Tailored support: establishing a credible NHS support model 4.Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning Major Milestones: a)Complete initial assessment (Jun 05) b)Complete national delivery plan (Dec 05) c)Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06) Major Milestones: a)Complete initial assessment (Jun 05) b)Complete national delivery plan (Dec 05) c)Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06) Analyse SHA returns Roll out of new sites Delivery of release 2 Conform Support model Increase number of GPs and specialties available Analyse SHA returns Roll out of new sites Delivery of release 2 Conform Support model Increase number of GPs and specialties available

Michael Thick. npfit.nhs.uk npfit.nhs.uk

Minimum a GP needs to do Creating an appointment request 6 October 2004

Authentication James Abbott

Setting the scene Busy Monday morning 5 minutes open surgery Dr Abbott has 25 patients to see in 2.5 hours

I think you need to see a specialist. Using the new Choose and Book service, we can book an appointment for you.

Choose and Book icon/button/function key GP System: Patient details page

The advantages for GPs Simple referral process Full directory of all the services available Decision support information to help GPs identify suitable services Advice and guidance facility Fewer queries from patients chasing referrals

The advantages for patients Greater opportunity to influence the way they are treated by the NHS Ability to discuss their treatment options so that they experience a more personalised health service Greater convenience and certainty reducing the stress of referral Choice of a place, date and time that suits them, enabling them to fit their treatment in with their life, not the other way around