Referral Management & Choice

1. Referral Management & Choice Tower Thistle, London 13th May 2004

2. eBooking and Choice. Prof. Michael Thick Consultant Transplant Surgeon National Medical Director Choose and Book Programme

3. BMJ, Jan 29th • …….offering choice to patients is no longer an option, indeed to deny them choice is to abuse them.

4. Benefits to the patient • Choice – patient selects preferred location from 4 or 5 providers • Convenience - patient selects most suitable time of appointment • Confidence – patient and clinician can be confident that referral, booking and any follow up appropriately actioned

5. Benefits underpinned by the NHS Plan • 100% daycases, 66% inpatient elective, 66% Outpatient by March 2004 • 100% daycases, inpatients and outpatients by Dec 2005 • “Waiting lists...replaced with booking systems...” • “There will be on the spot booking systems...” • “…there will be electronic booking...”

6. NHS Plan underpinned by …. • Expanded capacity - physical & manpower • Incentives for performance, including financial flows • Empowered patients • Post Wanless ICT

7. …..computers will be capable of imitating human intelligence, and indeed they will do so by the year 2000. “Computing machinery and intelligence .” Alan Turing 1950

10. Remember Prof Protti….. …the hard stuff is the soft stuff!

11. “Even at its scientific best, medicine is a social act” Davidoff, JAMA Aug 1998

12. Electronic Booking background • Nationally procured Electronic Booking Service (EBS) • Provided by EBS National Application Service Provider (EBS NASP) • Implemented by Local Service Provider (LSP), Cluster, SHAs, PCTs and Trusts • One LSP per Cluster • Bookings Management Service (BMS) provided locally

13. Shadow Communities • Basildon & Thurrock • Birmingham & Black Country • Bolton • Christies, Manchester • Durham & Tees • Medway & Swale • North Central London • North Mersey • Harrogate • St Helens’ • Somerset • Southampton & Winchester • South West London • Stockport • Walsall Local Pilots • Enterprise Communities • Develop and Demonstrate • Dorset, North West London, South East London • Planning & Procurement • Greater Manchester and West Yorkshire

14. Barnsley East Surrey & N W Sussex Luton Coventry & Warwick East Lancashire Hull and East Riding Chorley, S Ribble & Preston Airedale Peterborough East & South East London N E London Hampshire & Isle of Wight Leicestershire, Northamptonshire & Rutland York and Selby Worcestershire Cambridge, S Cambridge & Huntingdon Newcastle, Tyne & Wear Northern Lincolnshire & Goole 18 Pilots joined the programme - November 2002

15. Objectives for Electronic Booking Systems • give patients a choice of convenient date, time …and place…… for appointments and admissions • ensure services are designed around patients • use ICT to improve convenience • respond to innovation and the continuous development of services • the patient is an essential partner

16. Booking and referrals • GP – patient encounter • Refer now, book now • Refer now, book later • Refer later, book now • Refer later, book later • Seek guidance now, refer later, book later

17. Electronic booking components • Electronic Booking Service • Directory of services • Bookings Management Service

18. Electronic Booking Service • National service, linking primary care and service providers • Provides the means for “bookers” and/or the patient to: Choose place of treatment Make a booking Send referral documents • Uses a range of electronic channels: Direct on-line booking Telephone contact centres Internet and digital TV

19. Bookings Management Service • Acknowledges incomplete infrastructure • Supports patients and professionals in making, amending and cancelling appointments • Supports patients exercising choice

20. Potential BMS models • Industry model • Use existing NHS assets • Mixed economy

21. Directory of services • Details of available services, with booking guidance/protocols • Visible appointment slots • Selectable by specialty, sub-specialty, team, name, gender and distance. • Decision support • Linked to NHS.UK

22. The Booking Process

23. Business Processes

25. Dobson’s dream • An airline type booking system which contained every appointment in every hospital, and was available to every GP.

26. Milburn’s dream • To turn a screen towards a patient, and show them the five most suitable places for their treatment, allow them to choose, and then book the appointment.

27. Requirements for “Choice” • Services must be described in detail. • Organisations must populate NHS.UK • Commissioners must “purchase” service.

28. Choice • From 2005 patients will be able to: • Make decisions about their treatment, in partnership with a health professional • Choose from a menu of four or five options decided locally • Also can book their appointment at a convenient time and date • Electronic Booking is key to patient choice

29. Urgent “Choice” Issues (1) • Understand and support “referral centres” and GPSI’s • Care pathways and diagnostics key to engagement • Explaining 6 weeks holiday • Booking beyond 12 weeks • Vetting referrals • Passing on referrals

30. Urgent “Choice” Issues (2) • Who is qualified to give advice? (JR speaks!) • Can the BMS be used for choice? • Can a provider hold back slots? • “Out of area” commissioning • Booking beyond six weeks • Quality decides at commissioning level • Waiting list and pools vs names

31. Local engagement plans • Hold “awareness” sessions • For IM&T & Modernisation staff across the StHA patch • Delivered by the MA team : Nov 02 - Jan 03 • Understand baseline • Where are we with e-booking in each StHA patch ? • Form basis for implementation performance monitoring • Run this during October • Hold “trajectory planning” events • Aim to agree local plans to hit targets… • Run from November onwards to suit individual communities

32. Assumptions • Redesign is a fundamental part of introduction of bookings • Engaging clinicians is fundamental to redesign • This takes time and cannot be imposed - building on non electronic booking and other modernisation successes • Clinical engagement is the rate limiting factor to change • NPfIT supports the implementation of electronic booking.

33. Disillusioned Sceptics Enthusiastic Pragmatists High Grip on Reality Naïve Idealists Habitual Cynics Low Negative Positive Outlook

34. Emphasis on financial realism and transparent accountability Individualistic concepts of clinical work Systematised concepts of clinical work Emphasis on clinical purism and opaque accountability

35. Emphasis on financial realism and transparent accountability Individualistic concepts of clinical work Systematised concepts of clinical work Emphasis on clinical purism and opaque accountability

36. Clinical engagement • Done by “amplification” • Complementary to “top down” but quicker! • Take training to early users, and they become advocates for next adopters • Message stronger from recent converts • Involve colleges with pilots

37. AMPLIFICATION Summer ‘04 Unaware Evidence Time Leadership Comms Presentation Timetable Reward Toolkit EAs 1st Wave Dec ‘05 2nd Wave Dec ‘05 TIPPING POINT ? 3rd Wave

38. Implementation Timetable • Now – Organisational Readiness activities commence • Spring 2004 – Design and Build complete • Summer 2004 – Testing and Integration complete First “live” transaction via EBS • Winter 2005 – Roll-out to all LHCs within Clusters complete

39. Board 28/5 Board 5/3 Board 16/1 Board 16/4 Electronic Booking Programme Management Design, build and test Implementation Organisational Readiness Communications Contract Board 27/5 Contract Board 24/6 Contract Board 25/3 Contract Board 29/4 Contract Board 29/1 Contract Board 26/2 OGC Gateway 4 10-14/5 Electronic Booking ProgrammeOverall Timeframe – 2004/5 KM1 Ext design 16/2 KM2 Mod. testing 12/4 KM3 System testing 3/5 Wave 2 M.C. testing 6/9 KM4 Intgn. testing 28/5 Design Build & Module Test KM5 MC. testing 21/6 Sys. Test MCTesting Integration Testing MCTesting PoS 4 April Cluster Review Teams Appointed 16/1 C1&2 EAs identified 30/1 C3,4&5 EAs identified 27/2 C1&2 EAs Detail plans approved 15/3 C3,4&5 EAs Detailed plans approved 15/4 C3,4&5 Detailed plans approved 28/5 KM6 10 Bookings 1st wave 30/6 C3,4 & 5 EAs Cut-over plans approved 28/8 KM8 10 Bookings 2nd wave 30/9 Fully Booked NHS Dec 2005 C1&2 Detail plans approved 30/4 C1&2 EAs Cut-over plans approved 21/5 Business Process Manual complete DoS Guidance Issued to NHS C1&2 EA Training plans approved C3,4 & 5 EA Training plans approved KM7 Initial Training complete 1/9 C3,4 & 5 EAS BMS Go live 15/09 Guidance on Full Booking Issued 15/05 C1&2 EAs BMS Go live 20/6 BMS plans agreed Early adopter BMS in place Agency delivers C&M strategy Select agency for external C&M Key: EA = Early Adopter C1 = Cluster 1 C&M = Communications & marketing Green Shade = Complete Internal NHS C&M Strategy implemented Jan Feb Mar Apr May Jun July Aug Sep Oct Dec 2004 2005 Issued: 17/02/04 Rev: 0.9

40. General Issues • National Clinical reference panel • Implementation Plan • Duty of care • Confidentiality • Mental Health • Noise in the system

41. For further information www.modern.nhs.uk/booking