Choose & Book

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

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

3. 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

4. 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 (N3)

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

6. 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

7. 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’

8. 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

9. 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

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

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

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

14. 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

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

17. 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

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

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

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

21. 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

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

23. Conclusion 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

24. Speciality Clinic Type Service DoS Orthopaedic surgery Upper limb shoulders elbows

25. DoS Recommended service naming: Service name Mandatory Department name Mandatory Provider organisation name Mandatory Provider NACs code Mandatory

26. 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 Information held about a Service

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

28. General Surgery Specialty An example service structure … Clinic Types General Surgery Minor Surgery Upper GI Lumps & Bumps St Ann’s General Surgery St Ann’s Minor Surgery St Ann’s Upper GI St Ann’s Lumps & Bumps Services Appt slots

29. General Surgery General Surgery General Surgery General Surgery St Ann’s General Surgery St Ann’s Minor Surgery St Ann’s Upper GI St Ann’s Lumps & Bumps King’s General Surgery King’s Upper GI King’s Lumps & Bumps General + Minor Specialty How services are structured may vary … Clinic Types Services Appt slots

30. 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 Mr B Mr G Mr W General General General Heads Arms Legs What are my Services?A Simple Example

31. ……so how are we doing?!

32. 247 Days Left 743 Live bookings to date (as at 9/05/05) Bookings per LHC First Booking Date • 332 Barnsley 28 Jul 04 • 134 Haringey 02 Jul 04 • 109 Croydon 25 Jan 05 • 88 Harrogate 11 Feb 05 • 31 N Derbyshire 30 Sep 04 • 27 Chesterfield 06 April 05 • 11 Enfield 05 April 05 • 4 North Surrey 24 Jan 05 • 4 Islington 14 April 05 • Kingston www.chooseandbook.nhs.uk

33. Update since last meeting • Number of bookings increased from 480 to 743 since 13th April • Practices 55 • Specialties 49 • New PCTs 3 • 5 new sites due to go live in May • 19 out of 28 SHA returns • Development of programme and support model • Key Delivery Challenges: • Reforming patient pathways: diagnostic, surgical/medical, pre-referral • Measuring performance: accurately capturing the whole patient journey • Tailored support: establishing a credible NHS support model • Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning • Major Milestones: • Complete initial assessment (Jun 05) • Complete national delivery plan (Dec 05) • Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06)

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

35. Proof of concept – organising around key elements of delivery 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. 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. Working in partnership with Connecting for Health, DH and SHAs; monitoring and reporting on implementation timeframes; and escalating issues for resolution. Proof of Concept Snag list management Existing system supplier co-ordination Strategic plan development 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; identifying, prioritising and resolving support gaps; and escalating roll out problems for resolution. Primary care (capacity) project plan management Secondary care (capacity) project plan management

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

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

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

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

40. Support process Additional Support Planning Mobilisation Ongoing Support Ongoing Performance Management

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

42. 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. Mobilisation Mobilisation support at SHA level to maximise roll-out SHAs LHC NHS Trust ISProvider PCT Targeted support at high risk LHCs GDPs MH Trust

43. Ongoing Support • Access to help when things don’t work • Ongoing support from central team • Performance management • Recognition of achievement • Gather good practice • Availability of support

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

45. NPfIT Interfaces with Supplier helpdesks Roll-out support functions National Service Helpdesk Mobilisation and co-ordination of support Establishing Healthcare framework Negotiating fees with ESPs Part of NPfIT Will resolve technical issues or forward to NSD Supplier Connecting for Health Intervention Team Cluster Deployment Planning Group Deployment of available resources Escalation to Connecting for Health/SHA/Supplier Clusters SHAs Supplier Area Management Acute trusts PCTs RMU Supplier Account Management 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 GP Practices

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

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

48. Performance Management 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 Performance Management Performance Management Incentives

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

50. Michael Thick. michael.thick@npfit.nhs.uk 07879 615288