Choose and Book

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Choose and Book

• Community Services
• In
• Barnsley

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History

• October 2004 I.T. installation begins
• November 2004 First Physiotherapy Clinic on
  line
• December 2004 Second Physiotherapy clinic
• March 2005 M.S.K on line
• 1st April 2005 Mount Vernon Hospital Physiothe
  rapy

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• April 2005 6 Podiatry Clinics smaller
  sites
• September 2005 All Podiatry sites (17) and 6
  Physiotherapy sites.
• April 2006 Physio Neuro
• June 2008 Physio Respiratory
• 2005 Limited number G.Ps able to book via
  C B
• 2008 All G.Ps able to book on CB.
• Trust stopped paper referrals from
  G.Ps

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• Physiotherapy - Directly booked
• M.S.K - C.A.S
• Podiatry - Nail Surgery Directly booked
• - Remaining service C.A.S
• - May 2008 All Podiatry Services
  Directly booked

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Pre - History

• Physiotherapy
• Merged 15 sites 6 sites
• skill mix
• less travel
• reduced admin
• reduced set up
• reduced isolation of staff
• reduced equipment needs
• reduced expense
• Clinicians gained admin staff

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• Review criteria
• a lot tighter
• Created D.O.S
• Waiting list Initiative
• Routine bookings open 6 months
• Opened Acute Slots

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• Podiatry - Service Redesign
• Criteria tightened D.O.S
• C.A.S didnt trust G.P referrals
• New Discharge Procedure
• Set up a 1st Appt (EBS slot) in every clinic
• - FAILED !!!

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• Set up New Patient Only clinics ( All EBS)
• Reduction in sites
• 24 17
• Changed computer systems
• TCS Community System
• PAS Hospital System

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• Both Services
• More stringent in rejecting referrals.
• Inappropriate
• Lack of Details

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How it works for Community Services

• NOT a Community System
• NOT designed for AHPs
• Makes services look at how they operate
• Work more like Hosp. Consultants

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Physio

• Protected CB slots (EBS) in every session
• min. 2 40 mins
• Follow-up 20 mins
• Accept / Reject Referrals
• - Senior Clinicians
• - on site

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Podiatry

• Full Clinics protected EBS slot
• 7 pts session
• 30 min. - Assessment only
• 20 min. - Follow up
• Accept / Reject Referrals
• - A Senior Clinician
• - Centrally

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G.Ps

• View designated numbers of slots (Appts)
• SHOULD give patient the choice
  time/day/site
• SHOULD Attach referral within 3 days
• SHOULD Give patient service info and
  appointment letter

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Patients

• To change Appt
• - Phone NHS Direct
• - Phone G.P
• - Go on Internet
• Do this as many times as they like !!
• SHOULD NOT phone the service

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Patients

• Receive Standard Appointment letter
• Not written by service
• Very misleading
• Service Information
• Examples
• Urine Sample
• Shorts / T-shirt
• How long Appt will last
• Dont bring World and Wife
• If G.P gives it them !

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Clinicians

• Information Received
• Medical history
• Medication
• Reason for referral (hopefully)
• If off work due to condition
• Duration of symptoms
• Interpreter required
• Investigations x-rays / pathology tests

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Clinicians

• Generally referred to appropriate part of service
• DNA new patients increased
• Cancellations increased Wasted slots

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Process - Physiotherapy

• All Senior Clinicians have Smart Card
• Bring up CB Navigator
• View own clinic only
• Print off referral
• Accept / reject

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• Accepted - Referral put in record file
• Reject - Explain rejection and what to do
  with it.
• - Can redirect within service but make
  G.P do it.

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Podiatry - Process

• Designated Senior clinicians have Smart Card
• Bring up CB Navigator
• View all clinics
• Accept / reject

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• Accepted - Print Referral
• make up record file
• Send to clinical site
• Reject - Explain rejection and what to do
  with it.
• - Redirect within service

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Pros

• Redesign Services
• Business Plan MSK Physio
• Better Patient Information
• Patients Registered on to system
• Appts made on our behalf Reduced time
• I.T Systems in all clinics
• Referral quicker for service to pick up

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• Theoretically Pt has choice site / time
• Patient gets appt quicker
• Theoretically Pt. gets more info. Prior to
  appt
• Pt can change time or date via internet or phone
• More equitable service
• Easier to reject reduced admin time

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• Instant feedback to G.P
• Advertises your service
• Enables move to self referral

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Cons

• G.Ps
• Dont attach referral appropriately
• Dont follow criteria
• Book appt when pt not present no choice
• Dont look for appropriate slot
• Massive increase in admin time
• G.Ps and services

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• G.P admin often do CB. creates problems when
  admin staff not present
• Use inappropriate form on system scan own
• Dont inform Patient theyve been rejected
• Patients ring service to alter appointments
• Patient not given information letters
• We cant see what G.p sees but ring us for
  advice

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• Increased DNA rate
• Increased Printing (ink) and paper costs
• Increased late notification of cancellations
• System allows continual cancel/rebook without
  notifying services
• Highly reliant on I.T. get one of these!

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• Still not designed for Community services not
  changed in over 4 years.
• Inability to refer between services
  electronically escalated nationally but nothing
  changed.
• Lack of links to other systems
• PAS out dated non community system
• System One incompatible

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Any Questions?

• Helen Walker Physiotherapy Manager
• Physiotherapy Out Patients
• Mount Vernon Hospital
• Barnsley
• S70 4DP
• helen.walker_at_barnsleypct.nhs.uk
• Bob Senior Podiatry Manager
• New Street Health Centre
• Upper New Street
• Barnsley
• S70 1LP
• Bob.senior_at_barnsleypct.nhs.uk