1. Managing Choice & Demand Linking Access, Booking, Choice, Demand Management and Evercare

2. Context Clinical services strategy Clinical services strategy Biggest cost pressures: Biggest cost pressures: Unscheduled care Unscheduled care Tertiary services Tertiary services Reference costs - £1m saving across Reference costs - £1m saving across community services community services Arbitration Arbitration

3. EEMS PCT population 275,000

4. ABCDE Strategy Patient Centred approach Managing demand Offering Choice – who, where, how Waiting time management from referral Adapted Evercare model Using new opportunities (nGP Contract + new APMS, Primary Care Collaborative)

5. How Leatherhead pilot enhanced CDM, based on Evercare model maximising use of community hospitals, community teams + assistive technology PCT referral management centre & booking office Supports choice at point of referral Target referrals into 2 0 more appropriately Reduce outpatient waiting times Expert patients – direct self referral? Cobham DTC (May 2005)

6. GP Patient GP Referral Management Centre & Booking Office Collects & analyses referral info Feedback to GPs Triage Diagnostic tests Patient offered choice Choice confirmed Treatment Patient follow up & discharge Information to practices Practices refer with current waiting times for all choices available Changes in referral patterns tracked/use of PCT interface services reinforced Detailed comparative analysis to identify issues/trends for review Provides information on realtime basis - active system of feedback & information updates to support choice at referral Creates SAFETY NET - any referrals with avoidable long waits held at RMC and queried back to GP/Practice before releasing Transmission Issues RMC records and sends on GP referrals on day of receipt (max delay for referrals should be only 24 hours) All non emergency tertiary referrals routed via PCT panel - max delay for referrals should be 2 weeks Booking GP may book appointment (e-booking, fax or letter). OR, Patient may book appointment later after consulting diary/relatives etc (telephone). Booking office will contact GP if patient does not make contact within specified time Caldicott & Patient Confidentiality Patient identifiable information is recorded as it will be necessary to track patients through the referral system / offer them choice All reports from the RMC database will be non-identifiable Briefing paper on Caldicott being prepared Prior to commencement, these issues to be discussed and signed off by PCT Clinical Governance Lead & LMC Proposed new system Directory of Services Info template from NPFIT National & local database info re service options including waiting times Info re take up of choice to PCT Info re PCT interface services to challenge referrals to acute

7. Choice offered in GP surgery Option 1 PCT interface service Option 2 acute Option 3 acute Treatment of patient in PCT interface service or hospital Patient follow up (if required) Discharge Directory of Services Information included PCT interface service GP Diagnostic test and/or Treatment Patient Choice offered by GPSI/PSI if further treatment required Option 1 PCT interface service Option 2 acute Option 3 acute Treatment of patient in PCT interface service or hospital Directory of Services Information included The system is flexible– either of these options is also possible

8. Proposed System Patient GP Option 2: PCT Interface Services Web based DoS SW London LIS PCT Information National Guidelines Option 1: Acute Services Option 3: Acute Services Choice RiO/ Booking Office E refer E book

9. Proposed GP process GPPatient Directory of Services RiO Electronic Booking System RiO Electronic Booking System PCT Back Pain Interface Services PCT Back Pain Interface Services Referral Letter Referral Letter Booking Confirmation Booking Confirmation Instructions Surgery Staff BMS

10. EEMS Directory of Services How is choice offered Types of data held for each service includes: Service Information – e.g. who, where, what, waiting times. Clinical Information – e.g. the description of the services being offered and clinical referral guidelines. Practical Information – e.g. location maps, patient information leaflets, car parking fees, Cobham Booking Office contact details

11. PCT Back Clinic – Directory of Services

15. E-Referral & E-Booking using RiO System Find Clinic Find Appointment Book Appointment

16. Linking Booking, Choice Demand & Evercare Using RIO (an existing system) to test e- referrals & e-booking processes for interface services Developing PCT referral management centre & booking office - go live July Expanding/flexing flex diagnostic capacity - mobile equipment, PMS specialist for radiology Expert patients – promoting self management, using collaborative

17. Using learning from Choice for demand management Added value of Choice Patient has an informed debate Information for patients Clarity about implications of options What and when to type of treatment Culture change Step change Getting used to electronic system Impact on consultation & practice processes Bridging infrastructure gap between now and NPfIT