Offering Access and Enabling Choice using Choose and Book Allied Health Professionals Event South Ce

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Offering Access and Enabling Choice using Choose
and BookAllied Health Professionals EventSouth
Central SHA25 February 2009
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AGENDA FOR MORNING
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Offering Access Enabling ChoiceUsing Choose
Book
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Objectives for the day CFH Context Challenges
Influence Preparation Engagement
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High quality care for all NHS Next Stage Review
final report

• Raising standards
• Stronger involvement of clinicians in decision
  making at every level of the NHS
• Fostering a pioneering NHS

• Help to stay healthy
• Empowering patients
• Most effective treatments for all
• Keeping patients as safe as possible

Quality at the heart of the NHS

• Empowering frontline staff to lead change that
  improves quality for patients
• Valuing the work of NHS staff

High quality care for all
High quality care for patients and the public
Freedom to focus on quality
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Health record securely accessible to clinicians
and patients
Share information securely with partners
Delivering better, safer care Quality at the
heart of the NHS
Information available at the point of care
Personalised wellness support for patients
public
Improving clinical quality and safety
Empowering patients and the public. High quality
care for patients and the public
Empowering staff to improve NHS
performance. Freedom to focus on quality
Public access to health information
Improving performance management
Public access to service implementation
Improving information for staff
Information to support high quality care
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Key delivery systems

• Care Records Service SCR EHR
• Choose and Book
• Picture Archiving Communication System
• HealthSpace
• NHSmail
• NHS Choices

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Supporting work streams

• Access Controls
• Card Management
• Record visibility and legitimate relationship
• Secondary Uses Service
• Clinical Content
• SNOMED (Clinical Terms)
• Dashboards

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Clinical Dashboards
Locally tailored information, combined with
national benchmark metrics
Integration of multiple data sources, relevant to
multidisciplinary teams
Information presented clearly, with visual impact
Real time updates, assisting immediate, targeted
decisions and improved data quality.
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Prototype summary AE (Homerton)
Uses AE department system covering Majors /
Minors / CEA / PUCC In use throughout AE
department, on public display, and in clinicians
offices
Data Sources PAS and radiology feeds (every 10
minutes) London Ambulance Service (hourly)
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Secondary Uses Service SUS
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Information Data Standards Programme
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Choose and Book

• AHP services from 1st April 08
• Direct and Indirect Booking capabilities
• Over 11 million bookings
• Used by over 90 GP practices
• Supported by the Personal Demographic Service
  (PDS) processing almost 50 million transactions
  in a typical month.
• PDS replaces the NHS Strategic Tracing Service
  the 31st March 2009.
• Bookable through my HealthSpace
• Informed through NHS Choices

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AHPs Preparedness

• Develop the infrastructure
• Integrate activity Information
• Standardised Clinical Recording
• Share current engagement
• Understand the opportunities
• Develop utilise networks

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Overview of End to End Process
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End-to-end booking (indirect)
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End-to-end booking (direct)
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Demonstration using Unplugged- From a referrer
perspective- From a provider perspective
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End to end process Assessment Service
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Assessment Services
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My Experience of using Choose and Book

• Graham Croker National Clinical Lead

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Clinical Assessment Service models

• Referral letter reviewed (Review of Referral
  Letter CAS) In this type of CAS, the CAS
  clinician simply adds their expertise to the
  assessment of the referral information provided
  by the GP and the patient is then referred on or
  advice returned to the GP. This style can be used
  for diagnostic services where the diagnostics are
  delivered as day-case appointments.
• Telephone Consultation (Telephone CAS) A
  telephone CAS operates by taking referral
  information and then using a telephone
  conversation with the patient to gain additional
  information for the assessment.
• Patient physically seen (Face-to-Face CAS) In
  this model, the patient is physically seen and
  assessed by a clinical specialist at an allotted
  time. The patient is then referred to another
  service or the advice sent back to the patients
  GP to assist with management.
• Patient physically seen and diagnostics/
  treatment arranged (See and Treat CAS) This
  differs from the Face-to-Face CAS in that the
  clinicians or team that provide the assessment
  may also perform some diagnostics and treat the
  patient. Often these services are called
  Clinical Assessment and Treatment Services (CATS)
  / integrated Clinical Assess and Treat Services
  (iCATS).

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Who is doing what now
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AHP Bookings
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AHP bookings by Provider
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Data for Early Feb 2009
13,821,173 total bookings to date
Approx 25,000 outpatient bookings per day (26th
Jan 33,494)
80 of bookings are DBS
56 of referrals are made via CAB
90 of GP practices used CAB last week
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Recent booking activity
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Appointment activity
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Choose and Book in South Central SHA

• Sue Allan, CAB Choice Lead SC SHA
• 25 Feb 09

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Overview

• How are we doing with CAB in SC?
• How does this compare to the national picture?
• Issues affecting utilisation
• Drivers for improving uptake
• Progress in publishing AHP services
• How do we take this forward / next steps

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South Central progress

• January utilisation 53, compared with national
  picture of 58
• PCTs in SC range from 24 to 90
• Mixture of direct and indirect booking
• Mixture of processes from GPs using system
  directly to referral centres processing on their
  behalf although aim is to move away from this
  method to support patient choice

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Issues affecting utilisation

• Ability to do direct booking
• Due to delays with National Programme for IT
  several trusts in SC have not been able to offer
  directly bookable services. Situation improving
  slowly
• Appointment Slot Issues
• Where DBS sites do not make enough slots
  available to CAB and patient/referrer is unable
  to book an appointment
• GP uptake CAB historical reputation issues
• Still work to do in some areas to re-engage GPs

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Drivers for improving uptake

• Patient Choice/NHS Constitution
• CAB main vehicle for supporting the ability of
  referrers to identify options and offer choice to
  patients
• Legal duty on PCTs to ensure Choice is offered
  for elective referral to first consultant
  outpatient services
• Start of 18w pathway, quickest route for booking
  and transfer of referral information
• Clinical use of system to review, accept, reject
  referrals more efficient process
• 1 system for making referrals ease of use for
  referrers

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AHP progress

• Not good yet across SC but..
• Milton Keynes General has Dietetics services on
  CAB
• Started last Autumn
• All clinics available to CAB, all IBS, booked via
  central booking office
• Need to ensure clear mapping of CAB clinics to
  PAS clinics
• All clinicians within department review referrals
  on line on a rota basis
• Referrals mainly generic to aid this
• Initial confusion in some areas but feedback and
  communication with referrers has resolved early
  issues
• On the whole going very well - wish consultants
  in the trust could use to refer to dietetics too!

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How do we take this forward in SC?

• Learn from today what can CAB do for you?
• All PCTs have CAB leads do you know them?
• SC CAB user group meets monthly new users
  always welcome
• How can CAB support your business processes?

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Remember

• Choose and Book is not about implementing an IT
  solution but enabling a business change

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• Sue Allan
• Sue.allan_at_southcentral.nhs.uk
• 07825 448195

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AGENDA FOR AFTERNOON
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AHP Clinical Terminology on Choose and Book
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Specialties and Clinic Types

• Specialties and Clinic Types have to be used
  together to find services to refer to
• Specialty is a coarse filter
• Clinic Type is a fine filter and should
  describe a group of conditions / problems will
  vary according to specialty
• Currently 51 Specialties and typically between
  1-14 Clinic Types per Specialty
• Worked with NCRP representatives for AHP
  specialties to derive the current AHP Specialties
  and Clinic Types
• Revisiting all Clinic Types

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Clinic Types

• Clinic Types are used as a fine filter on CAB.
  They help to produce a more specific and relevant
  set of services for a patient, from which it
  should be easy for referrers to shortlist the
  correct ones.
• Each CAB service can be linked to one or more
  Clinic Types within a single CAB Specialty
  Diagram on next slide
• Even though providers can allocate more than one
  Clinic Type to a service, referrers can only
  select one Clinic Type for their service search.
• The National Choose and Book team, with input
  from members of the National Speciality Reference
  Group (NSRG), ensures that the available Clinic
  Type names adequately reflect groupings of
  services used within provider organisations, and
  that they are meaningful to referrers.
• We would like your involvement to ensure that CTs
  in AHP Specialties are correct

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Relationships between entities
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Mapping guidance

• The more specialised services should typically be
  mapped to a single Clinic Type whereas more
  generalised services should typically be mapped
  to most of the Clinic Types within a CAB
  specialty.
• General services may in addition be mapped to the
  Not Otherwise Specified (NOS) Clinic Type i.e.
  if the service covers more than is described by
  the other specific Clinic Types alone or in
  combination.
• General Services should not be mapped to the NOS
  Clinic Type alone (unless there really are no
  other suitable Clinic Types to map to) as
  referrers will be trained to only use the NOS
  clinic type if none of the other specific Clinic
  are suitable and hence will not be able to find
  general services only mapped to NOS.

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AHP clinical terminology - review

• Met with AHP leads on 11 November 2008 to
• provide an update on Choose and Book
• suggest a thorough review of clinical terminology
  with more involvement from the Specialty groups
• Specialty Leads have made suggestions /
  refinements for comment at these workshops
• More art than science!
• Remember Clinic Types should first and foremost
  be meaningful to referrers secondly, they should
  help you to manage a streamlined pathway

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Current Specialties and Clinic Types
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Current Specialties and Clinic Types
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New Specialties and Clinic Types
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SNOMEDSystemised NOmenclature of MEDicine
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Background

• This is the key development arising from the
  Finding Services Effectively project conducted in
  2005
• SNOMED is the clinical terminology system for
  Care Records Service
• R4.0 made SNOMED functionality available to
  providers
• Providers initially informed via Communiqué not
  to start assigning SNOMED terms to services
  until a pilot project had been conducted
• Refinements to the pool of SNOMED terms (to make
  them more GP appropriate) and significant
  Specialty / Clinic Type changes have been made
  prior to implementation
• Providers will be trained in February and March
  and will start loading SNOMED subsets early 2009
• R4.2 will make SNOMED functionality available to
  referrers implementation date still to
  confirmed but probably June 2009

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Common misunderstandings

• SNOMED is not a new terminology system that needs
  to learnt by CAB users it is intuitive
• Although all terms are coded, users will be
  working with common words and phrases that
  predominantly relate to conditions
• SNOMED does not require a change to the coding
  systems with which staff are familiar in primary
  or secondary care
• There is already a mapping to Read and ICD-10 /
  OPCS
• Referrers will not be forced to search using
  SNOMED

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How will SNOMED work with CAB?

• Each Clinic Type is associated with a set of
  SNOMED Clinical Terms (known as a subset) which
  contains all the relevant findings / conditions /
  procedures
• When services are defined, they are mapped to one
  or more Clinic Types this enables a Service
  Definer to apply appropriate SNOMED subsets
• Providers can fine-tune which Clinical Terms are
  associated with their services (i.e. add and
  remove terms)
• Referrers will be able to search for services
  which are associated with a clinical concept
• As now, further information about listed services
  is provided by the Service Name and within the
  service details

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New referrer screen initial display
N.B. The next few screens will not be available
until June 09
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Using the CAB SNOMED browser
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Selecting the right concept
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The results of a service search
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Current SNOMED terms for AHPs
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NHS Choices and AHP Services
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Free Choice

• Allied Health Professional services currently
  fall outside of the scope of Free Choice Policy,
  as this is restricted to patients being referred
  for a first (medical) consultant-led outpatient
  appointment
• Implications of exemption
• Can choose to put services on primary or
  secondary care menu
• Primary care menu services must be commissioned
  in order to be visible
• Secondary care menu visible to all
• All services on the Secondary care menu are
  visible on NHS Choices
• NHS Choices is a patient facing web application
  that provides them with information on available
  services and allows them to compare service
  providers

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NHS Choices home page
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NHS Choices - Provider search result
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NHS Choices - Provider Treatments offered
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NHS Choices - Treatment Detail
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NHS Choices - Healthspace
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Self Referral

• In October 2008 the DH supported an initiative to
  enable AHP services to move towards self referral
  pathways
• Self referral doesnt currently fit with the
  Choose and Book process which requires a GP to
  generate a Unique Booking Reference Number
• This has been raised with the CAB Medical
  Director for consideration
• However NHS Choices allows the detail of services
  to be visible to patients they could then
  contact the service directly

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Pre-requisites of loading a service on Choose and
Book
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Directory of Services webpage

• This page provides key information on all
  elements of a Directory of Services as well as
  the Directory of Service entry template
  www.chooseandbook.nhs.uk/staff/dos/decide
• Key requirements of all DoS entries
• NACS code
• Smartcards with appropriate roles (Service
  Definer, Service Provider Clinician, Booking
  Manager)
• Agreed referral management process

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Choose and Book Step by Step
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Choose and Book Step by Step
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Choose and Book Step by Step
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Options for IBS
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Choose and Book Step by Step
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Choose and Book Step by Step
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Choose and Book Step by Step
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Many thanksAny Questions?Queries should be
sent tomb-chooseandbook_at_dh.gsi.gov.uk