1. Instructions for using the NHS e-Referral Service Outpatient Pathway Modelling Tool

2. Introduction
The following slides will provide you with instructions on how to complete the Outpatient Pathway Modelling Tool. The tool will illustrate how using the NHS e-Referral Service in your organisation can reduce costs compared to paper based processes. Please note that the links embedded within this document only work when viewed in ‘presentation mode’.

3. Contents Background Accessing the Tool
Understanding and completing the Input and Results sheet
How to amend the work processes
Next steps

4. Background Managing referrals into the organisation
Processing referrals and appointing patients are significant elements of the whole Outpatient Pathway.
Processes for receiving and reviewing referrals along with appointing patients are many and varied - two major distinctions are Paper referral and Electronic referral.
The Modelling Tool maps seven variations of these two handling processes.

5. Paper Vs Electronic Hi level comparison
Paper Process – partial booking
Clerk
Date Stamp
Register Patient on PAS
Batch & Distribute
Secretary
Receive
Pass to Consultant
Clinician
Review
Accept
Batch and Send back to Appointments
Prep Letter to Patient
Post Letter
Patient
Receive Letter
Call Hospital
Agree Appointment with Patient
Book Appointment on PAS
Attends Appointment
Paper
full booking
partial booking
NHS e-Referral Service
Directly Bookable (online review)
Directly Bookable (paper review)
Indirectly Bookable (online review)
Indirectly Bookable (paper review)
Electronic Process – directly bookable service
Clinician
Log on to System
Review Referral
Accept
Patient
Attends Appointment
Click here if you wish to understand more about the paper and electronic processes

6. Outpatient Pathway Modelling Tool approach
Paper Process – partial booking
Clerk
Date Stamp
Register Patient on PAS
Batch & Distribute
Secretary
Receive
Pass to Consultant
Clinician
Review
Accept
Batch and Send back to Appointments
Prep Letter to Patient
Post Letter
Patient
Receive Letter
Call Hospital
Agree Appointment with Patient
Book Appointment on PAS
Attends Appointment
Each step in these processes has been timed with a range of providers throughout the country.
Agenda for Change pay bands plus on-costs have been used.
ALL of these elements can be adjusted in line with processes at the organisation.
Electronic Process – directly bookable service
Clinician
Log on to System
Review Referral
Accept
Patient
Attends Appointment

7. Understanding and completing the INPUT AND RESULTS sheet
The tool has a number of sheets of information. We will start with the ‘INPUT & RESULTS’ sheet.
The ‘INPUT & RESULTS’ sheet consists of tables and graphs. We will now look at these sections in more detail.

8. Understanding and completing the INPUT AND RESULTS sheet
At the top of the sheet are Introduction, Action and Key sections.
Each time a figure changes the tables and graphs will be populated to reflect the changes.
These results come from certain assumptions about steps within the defined processes and costs associated.
Click the screen to see how the information updates the sheet.
There are six numbered sections within this sheet.
You are required to enter information relating to your organisation in the yellow boxes. There are eight boxes in total on the ‘INPUT & RESULTS’ sheet which require completion.

9. Understanding and completing the INPUT AND RESULTS sheet
The Organisation name has now been entered and some of the fields within the sheet have been populated. Section 1 will now be completed by entering in the referral percentages to the left.
By answering two questions regarding how referrals are triaged and how paper referrals are booked, an overall monthly cost is available in the table below.
Entering the ODS code extracts information relating to that organisation and starts to populate the sheet

10. Understanding and completing the INPUT AND RESULTS sheet
The figures also populates the graphs at the bottom of the sheet to display a breakdown of the types of referrals and costs per process.
The ‘Estimated maximum process costs’ in the bar graph below are based on the current individual process costs detailed on separate sheets within the tool and will remain static. The ‘Locally input process costs’ will change if these processes are amended to reflect differences in your organisations way of working. We will look at the processes in detail later.

11. Understanding and completing the INPUT AND RESULTS sheet
Four further sections deal with:-
Section 2. Appointment Slot Issues
Section 3. Appointment re-bookings against paper referrals. Current feedback puts this at around 1 in 5 (20%)
Section 4. DNA rates
Section 5. Clinics not mapped to NHS e-Referral Service

12. Understanding and completing the INPUT AND RESULTS sheet
The information in Section 2 is populated when the ODS code is entered. The average number of ASI’s is calculated from the weekly ASI reports. This data has been taken from
1 January 2012 to 31 December 2012.
Entering your organisation information in Section 3 populates the table and also updates the overall graph at the bottom of the sheet which we will look at in a moment. Section 3 should only include rebookings initiated by the patient.
Entering your organisation information in Section 4 populates the table and completes the overall graph at the bottom of the sheet. Section 4 will already have some information showing which has been captured when you added your organisation code in Section 1.
Remember that, depending on your local processes, not all DNAs may be logged in your PAS/EPR systems. It is important that the overall DNA rate is as accurate as possible. In the unlikely event that you enter a trust wide rate lower than the NHS e-Referral Service rate you will see a negative number as a result.
The information required in Section 5 gives you an opportunity to review your services that are not currently on the NHS e-Referral Service. When Choose and Book (the system which the NHS e-Referral Service replaced) was implemented certain services were required to be placed on the system. You may now find that there are other services using paper referrals which can be added. For example, nurse-led clinics. The services not on the NHS e-Referral Service should be assessed to identify if any can now be added to the NHS e-Referral Service to gain additional savings.

13. Understanding and completing the INPUT AND RESULTS sheet
Section 6 summarises the total monthly and annual savings for your organisation from the information you have entered.

14. How to amend the work processes
We have tried to map out a series of common processes which we believe to be a good starting point for costing your current referral processes. You are able to modify these processes (except for eRS– DBS BEST PRACTICE) to more accurately reflect your organisation.
NHS e-Referral Service DBS paper review
The NHS e-Referral Service referral arrives electronically at the organisation with a provisional appointment booked. Triage/grading is completed by the consultant with paper print out from the system. The booked appointment is confirmed with the patient.
NHS e-Referral Service DBS online review
The NHS e-Referral Service referral arrives electronically at the organisation with a provisional appointment booked. Triage/grading by consultant online (in the NHS e-Referral Service ) the booked appointment is confirmed with the patient.
NHS e-Referral Service IBS online review
Patient calls provider with UBRN. Provider registers patient on PAS agrees an appointment with patient and notes this booked appointment with The NHS e-Referral Service . Triage/grading by consultant online (in the NHS e-Referral Service ) the booked appointment is confirmed with the patient.
Electronic Referral Processes
NHS e-Referral Service IBS paper review
Patient calls provider with UBRN. Provider registers patient on PAS agrees an appointment with patient and notes this booked appointment with The NHS e-Referral Service . Triage/grading is completed by the consultant with paper print out from the system. The booked appointment is confirmed with the patient.

15. How to amend the work processes
Paper PARTIAL booking Process
Paper referral arrives at the organisation and, usually following triage/grading by consultant, a letter is sent to the patient asking them to call the organisation to make an appointment.  Patient calls and is offered an appointment via telephone.
Paper Processes
Paper FULL Booking Process
Paper referral arrives at the organisation and, usually following triage/grading by consultant, a booked appointment is sent out to the patient.  Patients are given information to contact the organisation if the appointment is not suitable.
Click here to return to the introduction section

16. How to amend the work processes
Please use the tabs to decide which process you wish to view – Please note that the eRS– DBS BEST PRACTICE process can not be changed as it is best practice
We will select the ‘eRS– DBS ONLINE REVIEW’ tab and review the process.

17. How to amend the work processes
The process sheet is opened. At the top of each sheet you will find a summary which breaks down the cost of the process. If you amend any of the process information this calculation will be updated automatically and the information filtered through to the ‘INPUT & RESULTS’ sheet. We will now move down the process.
To track any of the processes simply follow the arrows from step to step.

18. How to amend the work processes
If any of the processes do not apply to your organisation you are able to amend the information.

19. How to amend the work processes
Click to update the process description below with further information.
We will now show you 3 examples of where changes might be required.
Example 1 - an organisation has a document management system where they need to record information. You can amend the process to reflect this.
Click the screen to see how this is done.

20. How to amend the work processes
As the process has been amended change the dropdown to ‘No’.

21. How to amend the work processes
You now need to enter comments to describe the changes that you have made to this process. The information you input here will feed through to a summary sheet listing all the changes you have made to any of the processes in the tool. We will look at the consolidated comments sheet when we have completed all the examples.
We will also increase the time taken to action the process. Which will update the ‘Cost of staff’ and ‘Total Cost’.

22. How to amend the work processes
Example 2 - amending the ‘Staff Band’ section. The process that we have just updated is to be undertaken by a Band 2 administrator.
Click the screen to see the new comment added and the ‘Staff Band’ field updated.

23. How to amend the work processes
The ‘Cost of staff’ figure has now reduced from £0.28 to £ The ‘Total Cost’ has also reduced.

24. How to amend the work processes
Example 3 – amending the ‘Sundries’ section. Your organisation sends out a leaflet with the appointment letter. Click the screen to see how this is changed and how the ‘Total Cost’ for this part of the process is reflected.
Click the screen to see the new description and comments added. As well as the ‘Sundries’ field updated.
You can now see the new description, comments added and the ‘Sundries’ field updated. The ‘Total Cost’ field has also automatically updated from £0.37 to £0.42.

25. How to amend the work processes
As previously mentioned, if any costs are amended, the summary at the top of the process sheet will update automatically.
Before we made the process changes, the ‘Total Cost’ for the ‘NHS e-Referral Service Directly Bookable Online Review Process’ was £ With the
changes that we made this has now been increased to £2.25.
These changes will also be reflected within the relevant areas on the ‘INPUT AND RESULTS’ sheet. The ‘CONSOLIDATED COMMENTS’ sheet has also been updated. We will look at this next.

26. How to amend the work processes
The ‘CONSOLIDATED COMMENTS’ sheet lists all the comment fields held within each process. If any part of a process is amended it details the changes within this sheet. You can easily see the changes which we made below as it is in the light pink colour.

27. Next Steps
Enter your organisational information within the ‘INPUT & RESULTS’ sheet
Review each of the processes
Update the processes, where required, to reflect your organisation’s way of working

28. Questions
Please refer any queries regarding completion of this Modelling Tool to your National Team representative/s:-.
Darren Hunter
Wasan Dixon
Sarah Delaney
Cumbria, Northumberland, Tyne & Wear
Durham Darlington & Tees
North Yorkshire & the Humber
Lancashire
Merseyside
Cheshire, Warrington & Wirral
Greater Manchester
West Yorkshire
South Yorkshire & Bassetlaw
Dave Redding
Sandra Lees
East Anglia
Essex
Hertfordshire & South Midlands
Leicestershire & Lincs
Michal Kuś
Nicki Sheppard
Carole Beardsmore
Bristol, North Somerset, South Gloucs
Bath, Gloucs, Swindon & Wiltshire
Birmingham & the Black Country
Arden, Herefordshire & Worcestershire
Shropshire & Staffs
Mike Harris Narda Ramrattan-Dass
London
Thames Valley
Kent & Medway
Liz Barfield
Nicki Sheppard
Devon Cornwall & Isles of Scilly
Wessex
Surrey & Sussex