Changes affecting Commissioning users

1. Release 5.0 Preview Changes affecting Commissioning users 20.09.2010 – Version 1.0

2. Overview of Changes Support for Alternative Care Pathways Commissioning Rule Changes Enquiries Total

3. Support for Alternative Care Pathways Background Prior to Release 5.0 the only way to restrict access to a service was for the Commissioner to commission the service as not available for initial referral. This function was only available for primary care menu services. The service was then only visible as an onward referral.

4. Support for Alternative Care Pathways Release 5.0 Functionality:- Providers of Primary or Secondary Care Menu services will be able to restrict access to their services for clinical reasons or to support Practice Based Commissioning. Providers will be able to set up pathways to the restricted services. These pathways need to be created so that the provider of a restricted service will be able to specify which services, organisations and/or individual clinicians may directly refer to, refer-on to and redirect to their restricted service. Primary Care Menu services will still need to be commissioned.

5. Support for Alternative Care Pathways The reasons for the change are: • To encourage service providers to put more specialist (tertiary) services onto Choose and Book, because restricted services are protected by identified care pathways. • To enable multiple practices, within the same practice based commissioning consortia, to refer into a specific service which is not available to other referrers. • To identify clear pathways of care for referrers.

6. Support for Alternative Care Pathways If a service is restricted then a clear pathway in will have to be identified. This service will be via one or more of three routes: authorised service, authorised referrer or authorised organisation.

7. Support for Alternative Care Pathways The following slides give examples of how this functionality might be used: • Prior assessment services • Tertiary or specialist secondary care services • Initial Referral (authorised referrers) • Practice Based Commissioning model (authorised organisations)

8. Prior Assessment Model The pathway is via the Newtown MSK Assessment Service. This service is an authorised service. Referrals received into this service are triaged and/or treated. Those referrals that are clinically appropriate can be referred on to the relevant restricted service. GPs wishing to send referrals to the restricted services will be directed to refer via the authorised service. Under local commissioning arrangements, Newtown Hospital provide an Orthotic Service and Village Hospital a specialised Podiatric Service with Surgical Input. Newtown PCT provide a community Physiotherapy service. These services are restricted and do not accept referrals direct from GPs. Newtown Hospital Orthotic Service Restricted Service Authorised Service Authorised Referrer Key Newtown Musculoskeletal Assessment Service Village Hospital Podiatric Surgeon Service Newtown Community Physiotherapy Service

9. Tertiary/Restricted Secondary Care Service Model Newtown Optical Assessment Service Restricted Service Authorised Service Authorised Referrer The National Eye Infirmary offers specialised tertiary services. These services are published on the national DOS as restricted services. The DOS entry lists all available authorised services that referrers can initially refer into. Key Village General Eye Clinic National Eye Removal Service Liverpool General Optical Clinic London Optical Assessment Centre National Optic Nerve Laser Surgery Service Clinicians within the authorised service are able to refer on to the restricted services where clinically appropriate Birmingham General Eye Clinic Bristol Eye Clinic

10. Initial Referral (authorised referrers) Newtown PCT Optical Assessment Service Restricted Service Authorised Service Authorised Referrer Key Newtown Hospital General Eye Clinic National Eye Removal Service Dr Smith from Newtown Surgery wants his patient to go to the National Eye Removal Service. He is notan authorised referrerso he cannotmake a direct referral to the National Eye Removal Service. The Authorised Services presented as his pathways are Newtown PCT Optical Assessment Service or Newtown Hospital General Eye Clinic and Village Hospital General Optical Clinic Village Hospital General Optical Clinic Dr Jones Village Community Health Centre Dr Browne Newtown Community Health Centre Mr Green Garden War Memorial Hospital Dr Jones from Village Community Health Centre wants his patient to go to the National Eye Removal Service. Dr Jones is a GPwSI and is an authorised referrerso he can make a direct referral to the National Eye Removal Service.

11. Support for Alternative Care Pathways How does this facilitate Practice Based Commissioning (PBC)? • A service can be set up on the Primary Care Menu and commissioned by a Primary Care Trust (PCT). • This service would be restricted, with the practices from the PBC consortia set up as Authorised Organisations. This would allow only these practices to refer into the restricted service. • The restricted service will be visible to unauthorised referring organisations (i.e. other practices) within the PCT but these practices will not be able to refer directly to the service (which will be marked as ‘restricted’), nor will there be any authorised service pathways for them to select towards such a service.

12. Practice Based Commissioning Model (Authorised Organisations) The service is defined as a restricted service. This particular service has no individual authorised referrers, and it is an initial referral service so there are no authorised services. Instead it is restricted to authorised organisations. In this case all of the practices within the PBC Group (Newtown) are authorised organisations. Both PBC Groups could be in the same PCT. Newtown Practice Based Commissioning Group provide a non-scalpel Vasectomy Service for all practices within the PBC Group. The service is not available to other practices within the PCT Newtown PBC Newtown Group Practice Restricted Service Authorised Service Authorised Organisation Key Newtown Surgery Newtown PBC Non-scalpel Vasectomy Service Dr Sweeting & Partners X Fourways Surgery Oldtown PBC Two Towns Group Practice Village Health Centre New Lane Surgery Village Road Surgery Beech Grove Practice

13. COPY MIKE’S ONE New Restricted Services Enquiry The Restricted Services Enquiry will show which services are restricted and the reason why. The Restriction Date/Time column shows the last time the service was restricted (which is updated each time this action is carried out) and the Restricted Count column shows how many times this has been done. There are also columns showing numbers of authorised services, organisations and referrers associated to each restricted service within the organisation. Fig 16. Restricted Services Enquiry

14. Commissioning Rules Change • Since the introduction of “Free Choice” commissioners have not needed to commission services on the Secondary Care Menu. • New functionality will no longer display ALL secondary care organisations and their services. These organisations will only be visible if they have a service on the Primary Care Menu. • This will enhance response times, as the Secondary Care Menu services are no longer being loaded for the commissioner to see. • The commissioner will now have access to the Directory of Services via a new tab, where they will be able to search and review service details of any service, Primary or Secondary Care Menu.

15. Commissioning Rules Change • If a service moves from the Primary Care Menu to the Secondary Care Menu and then back to the Primary Care Menu, any prior commissioning rules will re-appear. • They will also appear on the Commissioning shrub within Service Definer Maintain Services tab. • As part of the move to the Secondary Care Menu the service will automatically be end-dated with the date of the move. • This service would therefore need to be re-commissioned if moved back to the Primary Care Menu

16. Minor Change Enquiry Total • Whenever an enquiry is made, the results returned will be displayed with a total - ‘Results Returned – X’