choose & book michael thick national medical director for cab and pacs 12 th may 2005
TRANSCRIPT
Choose & Book
Michael Thick
National Medical Director for CaB and PACS
12th May 2005
Introduction
One part of the bigger picture
Current view of booking and choice!
How are we doing?
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
NHSCfH ProgrammeElectronic 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)
Electronic booking components
Electronic Booking Service (EBS)CAB Software (Atos)
Directory of services (DoS)
Bookings Management Service (BMS)
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
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’
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
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
BMS scope
make a bookingalso change, track and cancel bookings
facilitate choice of date
time
location (directory of services)
first outpatient appointment
Directory of services (DoS)available services
booking guidance/protocols
visible appointment slots
selectable by specialty
team
name
gender
distance
linked to NHS.uk
GP/patient
Primary care system
Consultant/patient
CAB
Internet BMS
PAS system
Available appt. slots
Booked appt. slots
Directory ofservices
Provider infoPCT
Commissioning rules
Appt. reminders
DNA queries
Referral letterAdvice &guidance
Choose and Book
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
A toolis
only useful if you know what it is and
how to use it…
Advantages
no lost referral letterslegible lettersfewer steps
from decision to refer to patient attendance
choice at the point of referral
a new service - Advice and Guidance
Advantages
better care for all if templates/protocols are followed
patients appropriately worked up in advanceXrays and bloods etc
Managerial advantages
a full audit trail is available
no lost referral letters
fewer cancelled appointments
ConcernsGPs
historic practicelack of interest in IT
perceived lack of time
belief that this will all go away
ConcernsHospital
Consultants“no control” over referral
referral to other services or hospitals
belief that this will all go away
Clerical staffredundant
cancellations
follow-up appointments
Conclusion
Choose & Book is here to staywe all need to be prepared
Bookingthe engine which delivers patient choice
Clinical input vitalto set up referral trees
to set up DoS
to avoid “inappropriate” referrals
sell our services
be ready for PBR, practice based commissioning
Conclusion
DoS
Speciality
Clinic Type
Service
Orthopaedic surgery
Upper limb
shoulders elbows
DoS
Recommended service naming:
Service name Mandatory
Department name Mandatory
Provider organisation name Mandatory
Provider NACs code Mandatory
Information held about a Service
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
A specialty is a treatment function
A clinic type is a sub-categorisation of a specialty (nationally defined)
Specialty
General Surgery 100
Urology 101
General Surgery
Minor Surgery
Upper GI
Lumps and Bumps
General Urology
Urodynamics
Haematuria
Fast Track
Clinic Type
Colorectal Surgery 104
Vascular Surgery 107
Colonoscopy
Colorectal
General Rectal
Flexi Sigmoidoscopy
General Vascular
Doppler Test
General Surgery Minor Surgery Upper GI Lumps & Bumps
General Surgery
General Surgery
St Ann’s Upper GI
St Ann’s General Surgery
St Ann’s Lumps & Bumps
St Ann’s Minor Surgery
Specialty
Services
Appt slots
Clinic Types
An example service structure …
How services are structured may vary …
General Surgery
St Ann’s Upper GI
St Ann’s General Surgery
St Ann’s Lumps & Bumps
St Ann’s Minor
Surgery
General Surgery
General Surgery
General Surgery
King’s Lumps & Bumps
King’s General Surgery King’s
Upper GI
General + Minor
General Surgery
General Surgery
Specialty
Clinic Types
Services
Appt slots
What are my Services?A Simple Example
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
General
Arms
Mr B
General
Legs
Mr G
General
Heads
Mr W
……so how are we doing?!
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
Update since last meeting
Key Delivery Challenges:1. Reforming patient pathways: diagnostic,
surgical/medical, pre-referral
2. Measuring performance: accurately capturing the whole patient journey
3. Tailored support: establishing a credible NHS support model
4. Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning
Key Delivery Challenges:1. Reforming patient pathways: diagnostic,
surgical/medical, pre-referral
2. Measuring performance: accurately capturing the whole patient journey
3. Tailored support: establishing a credible NHS support model
4. Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning
Major Milestones:
a) Complete initial assessment (Jun 05)
b) Complete national delivery plan (Dec 05)
c) Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06)
Major Milestones:
a) Complete initial assessment (Jun 05)
b) Complete national delivery plan (Dec 05)
c) Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06)
• 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
• 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
Choose and Book Implementation
Choose andBook
Programme
Assurance of Choice
Assurance of Choice
IT Roll-OutIT Roll-Out
Performance ManagementPerformance Management
Proof ofConceptProof ofConcept
Comms &StkH. management
Programme Management
Service Implementation
Proof of concept – organising around key elements of delivery
Proof of Concept
Strategic plan development
Strategic plan development
Existing system supplier co-ordination
Existing system supplier co-ordination
Secondary care (capacity) project plan management
Secondary care (capacity) project plan management
Primary care (capacity) project plan management
Primary care (capacity) project plan management
Snag list management
Snag list management
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.
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.
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.
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.
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.
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.
Working in partnership with Connecting for Health, DH and SHAs; monitoring and reporting on implementation timeframes; and escalating issues for resolution.
Working in partnership with Connecting for Health, DH and SHAs; monitoring and reporting on implementation timeframes; and escalating issues for resolution.
Proof of Concept
0
100
200
300
400
500
600
700
800
02-Jul 2004
29-Jul 2004
08-Oct 2004
13-Oct 2004
25-Oct 2004
05-Nov 2004
23-Nov 2004
26-Nov 2004
06-Dec 2004
09-Dec 2004
14-Dec 2004
17-Dec 2004
30-Dec 2004
06-Jan 2005
12-Jan 2005
18-Jan 2005
21-Jan 2005
26-Jan 2005
31-Jan 2005
03-Feb 2005
08-Feb 2005
11-Feb 2005
16-Feb 2005
21-Feb 2005
24-Feb 2005
01-Mar 2005
04-Mar 2005
09-Mar 2005
14-Mar 2005
17-Mar 2005
22-Mar 2005
29-Mar 2005
01-Apr 2005
05-Apr 2005
08-Apr 2005
13-Apr 2005
16-Apr 2005
20-Apr 2005
23-Apr 2005
27-Apr 2005
03-May 2005
06-May 2005
Week ending
Booking totals are at close of business 9/5/5
0
100
200
300
400
500
600
700
800
02-Jul 2004
29-Jul 2004
08-Oct 2004
13-Oct 2004
25-Oct 2004
05-Nov 2004
23-Nov 2004
26-Nov 2004
06-Dec 2004
09-Dec 2004
14-Dec 2004
17-Dec 2004
30-Dec 2004
06-Jan 2005
12-Jan 2005
18-Jan 2005
21-Jan 2005
26-Jan 2005
31-Jan 2005
03-Feb 2005
08-Feb 2005
11-Feb 2005
16-Feb 2005
21-Feb 2005
24-Feb 2005
01-Mar 2005
04-Mar 2005
09-Mar 2005
14-Mar 2005
17-Mar 2005
22-Mar 2005
29-Mar 2005
01-Apr 2005
05-Apr 2005
08-Apr 2005
13-Apr 2005
16-Apr 2005
20-Apr 2005
23-Apr 2005
27-Apr 2005
03-May 2005
06-May 2005
Week ending
Booking totals are at close of business 9/5/5
Performance managementWeekly performance management and in-depth analysis
of problems to target resources
Planning & project management Establish project governance structures, roles and
responsibilities and targets
Technology troubleshootingEstablish process for problem identification, escalation and
resolution
NED engagementMaking Choose and Book a priority
Benefits realisation Identify potential benefits and realise through
implementation
GPs liveAgreeing a joint PCT/GP practice plan
Specialities liveAgreeing a speciality roll out plan
Patient focused communicationIncrease demand for the Choose and Book service
Focus areas
IT Roll-Out
IT Roll-OutExisting System
SuppliersExisting System
Suppliers
Technical Support to ImplementationTechnical Support to Implementation
Patient AccessPatient Access
Registration Authority
Registration Authority
DevelopmentDevelopmentDeployment frameworks agreed with McKesson, iSoft, Seetec and IPS
Deployment frameworks agreed with McKesson, iSoft, Seetec and IPS
Release 2 remains on target for delivery late Spring 2005
Release 2 remains on target for delivery late Spring 2005
Registration processesRolled out
Registration processesRolled out
Registration kit in placeRegistration kit in place
BMS and patient information
BMS and patient information
Service implementation
ServiceImplementation
StakeholderManagementStakeholderManagement
ImplementationToolkit
ImplementationToolkit
Implementation Programme
Implementation Programme
Site Support
Site Support
ImplementationStrategy
ImplementationStrategy
Performance ManagementPerformance Management
SHA mobilisation support Additional support to LHCs
SHA mobilisation support Additional support to LHCs Co-ordination of IT roll-out and
delivery of service changeCo-ordination of IT roll-out and delivery of service change
Developing a user friendly set of materials to support the service in implementation
Developing a user friendly set of materials to support the service in implementation
Encouraging organisational supportEncouraging organisational support
Service implementation support
Centrally based, flexible support team with expertise and influence directed to enhance local skill and confidence and focus on risk areas
Centrally based, flexible support team with expertise and influence directed to enhance local skill and confidence and focus on risk areas
SHAsSHAs
PCTPCT
MHTrustMH
Trust
NHSTrustNHSTrust IS
ProviderIS
Provider
Support SHA MobilisationSHA strategic/cluster deliverySupport SHA Mobilisation
SHA strategic/cluster delivery
Direct Support
Site specific, additional support
Direct Support
Site specific, additional support
LHCand
GDPs GDPs
Support process
Ongoing Performance Management
Planning MobilisationOngoing Support
Additional Support
Planning
• Increase organisational support
• Co-ordinate IT delivery and service change
• Myth busting
• Directory of Guidance
•Technical steps
•Clarifying Choice assurance
•Outpatient scheduling
Mobilisation
SHAsSHAs
PCTPCT
MHTrustMH
Trust
NHSTrustNHSTrust IS
ProviderIS
Provider
LHC
GDPs GDPs
Mobilisation support at SHA level to maximise roll-out
Mobilisation support at SHA level to maximise roll-out
Targeted support at high risk LHCs Targeted support at high risk LHCs
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.
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.
Stage 5Ongoing Perf
Mgmt
Stage 1Preparation
Stage 2Readiness
Assessment
Stage 3Planning
Stage 4Implementation
Stage 5Ongoing Perf
Mgmt
Stage 1Engagement and
Planning
Stage 2Toolkit
handover
Stage 3LHC Readiness
Assessment
Stage 4Implementation
• Access to help when things don’t work
• Ongoing support from central team
• Performance management
• Recognition of achievement
• Gather good practice
• Availability of support
Ongoing Support
Additional Support
SHAsSHAs
PCTPCT
MHTrustMH
Trust
NHSTrustNHSTrust IS
ProviderIS
Provider
LHC
GDPs GDPs
SHA monitors and reports performance –central support available to SHAs
SHA monitors and reports performance –central support available to SHAs
Targeted support at high risk LHCs Targeted support at high risk LHCs
Nature of additional support post-mobilisation to be informed by lessons learnt from roll-out. Supported by centrally based
team, aligned to geographical areas.
Nature of additional support post-mobilisation to be informed by lessons learnt from roll-out. Supported by centrally based
team, aligned to geographical areas.
Stage 5Ongoing Perf
Mgmt
Stage 1Analysis
Stage 2Diagnostic
Stage 3Planning
Stage 4Implementation
Stage 5Ongoing Perf
Mgmt
Stage 1Agree nature ofSupport
Stage 2 Stage 3
PlanningStage 4
ImplementationEngagement and
diagnosis
Roll-out support functions Roll-out support functions
Connectingfor
Health
Connectingfor
HealthSupplierSupplier
SHAsSHAsClustersClusters
RMURMU PCTsPCTs Acute trustsAcute trusts
GPPractices
GPPractices
NationalService
Helpdesk
NationalService
Helpdesk
InterventionTeam
InterventionTeam
Central planning and co-ordination of support deployment in each clusterAccountable to Cluster BoardSupport: Technical support to PCTs/trust/GPs during roll-out Planning:Collate all PCT plans and update SWIP
Central planning and co-ordination of support deployment in each clusterAccountable to Cluster BoardSupport: Technical support to PCTs/trust/GPs during roll-out Planning:Collate all PCT plans and update SWIP
Cluster Deployment Planning GroupDeployment of available resourcesEscalation to Connecting for Health/SHA/Supplier
Cluster Deployment Planning GroupDeployment of available resourcesEscalation to Connecting for Health/SHA/Supplier
SupplierAccount
Management
SupplierAccount
Management
Supplier Area
Management
Supplier Area
Management
Mobilisation and co-ordination of supportEstablishing Healthcare frameworkNegotiating fees with ESPsPart of NPfIT
Mobilisation and co-ordination of supportEstablishing Healthcare frameworkNegotiating fees with ESPsPart of NPfIT Will resolve
technical issues or forward to NSD
Will resolve technical issues or forward to NSD
NPfITInterfaces with Supplier helpdesks
NPfITInterfaces with Supplier helpdesks
Existing Delivery Support Resource
technical
project management
training
central support
Existing Delivery Support Resource
technical
project management
training
central support
Connectingfor
Health
Connectingfor
HealthSupplierSupplier
SHAsSHAsClustersClusters
RMURMU PCTsPCTs Acute trustsAcute trusts
GPPractices
GPPractices
NationalService
Helpdesk
NationalService
Helpdesk
InterventionTeam
InterventionTeam
BIM
RMU tech support
LBCs
Existing Systems& Suppliers LeadExec Leads
C&B PM
National trainers
Local trainers
Clinical LeadsSupplierAccount
Management
SupplierAccount
Management
Supplier Area
Management
Supplier Area
Management
Supplier Area Mgr
Supplier Account Mgr
C&B PM
C&B PM
Assurance of Choice
Assurance of Choice
Assurance and Monitoring
Assurance and Monitoring
CommissioningCommissioning
Public Awareness
Public Awareness
Information Provision
Information Provision
Implementing Choice
Implementing Choice
Performance Management
Performance Management
Performance Management Performance Management IncentivesIncentives
Reporting template completed Utilisation measure finalised and communicated through STEIS webpageFirst data return (May) due in June
Reporting template completed Utilisation measure finalised and communicated through STEIS webpageFirst data return (May) due in June
Final clarification for stage 1 incentive scheme issued end of May
Final clarification for stage 1 incentive scheme issued end of May
Next steps
Key Delivery Challenges:1. Reforming patient pathways: diagnostic,
surgical/medical, pre-referral
2. Measuring performance: accurately capturing the whole patient journey
3. Tailored support: establishing a credible NHS support model
4. Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning
Key Delivery Challenges:1. Reforming patient pathways: diagnostic,
surgical/medical, pre-referral
2. Measuring performance: accurately capturing the whole patient journey
3. Tailored support: establishing a credible NHS support model
4. Maximising impact of system reform: choice, IS procurement, Payment by Results, Practice Based Commissioning
Major Milestones:
a) Complete initial assessment (Jun 05)
b) Complete national delivery plan (Dec 05)
c) Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06)
Major Milestones:
a) Complete initial assessment (Jun 05)
b) Complete national delivery plan (Dec 05)
c) Interim indicative milestone of maximum 26 week waits for MRI and CT scans (Mar 06)
• Analyse SHA returns
• Roll out of new sites
• Delivery of release 2
• Conform Support model
• Increase number of GPs and specialties
available
• Analyse SHA returns
• Roll out of new sites
• Delivery of release 2
• Conform Support model
• Increase number of GPs and specialties
available
Minimum a GP needs to do
Creating an appointment request
6 October 2004
Authentication
1234567891000
James Abbott
Setting the scene
Busy Monday morning 5 minutes open surgery Dr Abbott has 25 patients to see in 2.5 hours
I think you need to see a specialist. Using the new
Choose and Book service, we can book an appointment for
you.
Choose and Book icon/button/function key
GP System: Patient details page
The advantages for GPs
Simple referral process Full directory of all the services available Decision support information to help GPs identify
suitable services Advice and guidance facility Fewer queries from patients chasing referrals
The advantages for patients
Greater opportunity to influence the way they are treated by the NHS
Ability to discuss their treatment options so that they experience a more personalised health service
Greater convenience and certainty reducing the stress of referral Choice of a place, date and time that suits them, enabling them to
fit their treatment in with their life, not the other way around