CHOICE APPOINTMENTS

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CHOICE APPOINTMENTS

• Robert Jones Fiona Jenkins
• East Sussex Hospitals South Devon
• NHS Trust Healthcare Trust

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In the beginning

• NHS Clinical Strategists INSEAD programme 2003-04
• Projects
• Fiona South Devon Stroke review and service
  redesign
• Rob Choice Appointments,Physiotherapy led
  post- op clinics, surgery, orthotic service
  redesign Collaborative working

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Collaborative Working

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A Framework for the Management of Change

• Triggers for Change
• Moving From the Current to the Desired
• Essential Actions
• Skills for Success
• Evaluation
• Learning Points

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Musculoskeletal Physiotherapy Outpatient
Appointments

• Up to 30 of all GP consultations are for
  musculoskeletal conditions
• Accounts for 34 of our physiotherapy services
• Referral source includes GP, Consultant and self
• Ease of access and minimal waiting times maximise
  effectiveness of treatment
• Did Not Attends represent wasted resource

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Challenges

• DNA
• 11-17 in our areas
• Significant numbers with 15-20
• Up to 48 in others
• Waiting times
• Up to 16 weeks for routine in our areas
• Significant numbers up to 6 months
• 156 weeks routine wait is known!
• Complaints

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Satisfaction

• Patient satisfaction
• Desire to get better and return to function
  quickly
• Complaints about waiting time
• Staff satisfaction
• Prompt treatment is clinically effective
• Improved job satisfaction
• Provide proactive service with well scheduled
  time management

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Choice Appointments

• Departmental demand and capacity calculated
• Patient referred for outpatient physiotherapy
• Patient telephones to book an appointment on the
  day that they want treatment
• Minimal pre booking
• Patient set goals to achieve before re accessing
  further treatment
• Follow up appointments managed in the same way

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Eastbourne Paul Phillips and outpatient team
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Identify Triggers for Change

• DNAs
• Waiting Times
• Feedback
• Political Imperatives
• Physio Direct

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Capacity Planning

• Triggers for change
• Understand demand
• Calculate capacity
• Manage change within team
• Optimise patient choice
• Patient decisions making

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Essential Actions

• 30 Minute Slots
• 10 NP
• 1 x 60 mins Assessment
• 4 x 30 mins Appointments
• Staff Timetable
• Same Day Booking
• Implementation
• Transferability

• Staff Participation
• Setting the Direction
• Specification Phase
• Implementation
• Determine Evaluation Parameters

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TorbayFrances Hunt and team
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Results

• Eastbourne
• System in place for 3 years
• South Devon
• 6 months

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DNA
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Routine Waiting time (weeks)
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Waiting time complaints
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Evaluation

• 2 audits in both sites
• Patient satisfaction of those who attended
• Feedback from those who failed to make contact.
• 1 audit of workshop attendees

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Audit 1 Patient experience of accessing
physiotherapy out patient service

• Audit objectives
• Standards
• Population
• Method - PPI
• Analysis of results

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Was information provided by the physiotherapy
service about appointment system clear?
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Would any other information have been useful?
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Did you find it easy to contact the
physiotherapy department?
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Key messages from Eastbourne

• Over 94 patients were satisfied with access,
  timing and organisation of appointment.
• Judging by previous appointment I felt very
  lucky to get through so quickly
• Not a long wait on the phone
• Excellent system.

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Patient Feedback Eastbourne

• I was very impressed by the Eastbourne DGH
  physio dept. Yesterday I had a letter about
  their patient choice scheme inviting me to
  phone for an assessment appointment and at
  10.00am I was being seen. Short of sending a
  physiotherapist to meet me at the ward on
  discharge the serviced could not be
  bettered!Thanks for your efforts on my behalf
• Extract from a patients letter to his OT at RNOH

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Key messages from Torbay

• 85 positive feedback
• Need dedicated cohesive team
• No waiting list!
• the system seems efficient and responsive to
  patient needs
• totally satisfied with phone in on the same day
• the service has been first class and really
  excellent
• .can choose the time which is convenient to
  you

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Learning points

• Signage to the department could be better
• Car park fees!
• Perhaps too much information
• Problems with getting through on the phone
• Action Plan

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Audit 2 Failed to make contact

• Audit objectives
• Standards
• Population
• Method
• Analysis of results

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Eastbourne results

• Reasons for not making contact
• 4 Unable to make contact
• 10 Did not know it was necessary to make contact
  with physio department to make appointment
• 24 Got better didnt need appt
• 15 Unable to afford time due to work pressures
• 8 Arranged own private treatment
• 2 Moved away
• 3 Previous treatment for same problem
• 29 Other reasons

• 3 month period, letter sent to all non attenders
  for 1st and follow up appointment 250 letters
  (15 of referrals)
• 95 responded (38)

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Comments Eastbourne

• Apologies but thought if I didnt ring it would
  be taken that all was well.
• As I had to make an appointment rather than being
  sent one I thought it unnecessary to phone
• Didnt realise I had 28 days to make an
  appointment sorry
• Would be easier to book several advance
  appointments
• 10 patients claimed not to have received a letter
  to ask to make an appointment.
• As I hadn't heard from you I went to a
  Chiropractor who I am still seeing

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Audit 2 Torbay results

• Reasons why patients didnt attend
• 31 got better
• 25 didnt know they had to make contact
• 8 unable to get time off work
• 7 arranged private Physiotherapy
• 1 found previous physio unsuccessful
• 8 unwell
• 7 UTA for social reasons
• 4 were now having treatment
• 2 unaware they had been referred
• 2 awaiting other investigations

• 22 of all patients who were referred failed to
  attend
• Audit returned by 15 of the above

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Comments Torbay

• Though we thought telephone access was a problem
  this was not highlighted
• Hasnt changed pattern of patients who only
  attend once - need to look further to determine
  whether we are discharging a higher proportion
  after one treatment.

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Audit 3-workshop attendees

• 50 people trained
• longest waiting time 156 weeks
• Highest DNA 48
• 16 replies
• Variable implementation
• Further requests to run workshops in North of
  England and Wales

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Future Actions Eastbourne

• Staff Audit
• Extending Choice appointments to other
  physiotherapy departments
• Extending to other specialties
• Extend to other disciplines
• Ongoing evaluation

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Future Actions Torbay

• Staff working at 75 capacity
• Afternoons more booked than mornings- need to
  look at staff rostering
• Opened phone lines earlier- new phone system on
  its way!
• Pre book following morning early slots
• 9th October develop system to include direct
  access for all Torquay
• 10th October Briefing session with staff and
  consider roll out to other departments
• Reviewing AE referral process
• Need to address outcome measure use as more
  people are only being assessed and treated once.

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Choice Appointments and Direct Access
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Challenges for the Future

• Commissioning Arrangement
• PBC
• Self Referral
• Organisational Arrangements
• PCT Reconfiguration
• Provider/purchaser arrangements
• Configuration of AHP services
• National workforce planning agenda
• Rolling out to other disciplines
• Wider NHS impact

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Communication

• Discussed model with DH
• Have run seminars to explain Choice
  Appointments 50 different departments have
  attended, auditing their implementation
• National and International lectures and workshops
• Presentation to NHS III

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JJ Consulting

• We are pleased to provide to provide training
  in the form of presentations and workshops on a
  range of NHS Management/Leadership issues
  (including "Choice Appointments)
• Website www.jjconsulting.org.uk
• e-mail rf_at_jjconsulting.org.uk

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And finally
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Contact

• robert.jones_at_ESHT.nhs.uk

• fc.jenkins_at_nhs.net