Managing Choice& Demand

Linking Access, Booking, Choice, Demand Management and

‘Evercare’

ContextContext

Clinical services strategyClinical services strategy

Biggest cost pressures:Biggest cost pressures: Unscheduled careUnscheduled care Tertiary servicesTertiary services

Reference costs - £1m saving across Reference costs - £1m saving across

community servicescommunity services

Arbitration Arbitration

EEMS PCT population EEMS PCT population 275,000275,000

225500

1030

436555845 Well'

High risk

Chronic Disease

Long term chronicdisease

ABCDE StrategyABCDE Strategy

Patient Centred approach Managing demand Offering Choice – who, where, how Waiting time management from referral Adapted Evercare modelUsing new opportunities (nGP Contract + new APMS, Primary Care Collaborative)

HowHowLeatherhead pilot enhanced CDM, based on Evercare model maximising use of community hospitals,

community teams + assistive technologyPCT referral management centre & booking office Supports choice at point of referral Target referrals into 20 more appropriately Reduce outpatient waiting times

Expert patients – direct self referral?Cobham DTC (May 2005)

GP Patient GP

Referral Management Centre & Booking Office • Collects & analyses referral info• Feedback to GPs• Triage• Diagnostic tests

Patient offered choice

Choice confirmed

TreatmentPatient

follow up & discharge

Information to practices• Practices refer with current waiting times for all choices available • Changes in referral patterns tracked/use of PCT interface services reinforced• Detailed comparative analysis to identify issues/trends for review • Provides information on realtime basis - active system of feedback & information updates to support choice at referral • Creates SAFETY NET - any referrals with “avoidable long waits” held at RMC and queried back to GP/Practice before releasing

Transmission Issues• RMC records and sends on GP referrals on day of receipt (max delay for referrals should be only 24 hours) • All non emergency tertiary referrals routed via PCT panel - max delay for referrals should be 2 weeks

Booking• GP may book appointment (e-booking, fax or letter). OR,• Patient may book appointment later after consulting diary/relatives etc (telephone). Booking office will contact GP if patient does not make contact within specified time

Caldicott & Patient Confidentiality• Patient identifiable information is recorded as it will be necessary to track patients through the referral system / offer them choice • All reports from the RMC database will be non-identifiable • Briefing paper on Caldicott being prepared • Prior to commencement, these issues to be discussed and “signed off” by PCT Clinical Governance Lead & LMC

Proposed new system

Directory of Services• Info template from NPFIT• National & local database• info re service options including • waiting times• Info re take up of choice to PCT• Info re PCT interface services to challenge referrals to acute

Choice offered in GP surgery

Option 1

PCT interface service

Option 2

acute

Option 3

acute

Treatment of patient in PCTinterface service or hospital

Patient follow up (if required)Discharge

Directory of S

ervices

Informatio

n included

PCT interface service

GP

Diagnostic test and/or Treatment

Patient Patient

Choice offered by GPSI/PSI if further treatment required

Option 1

PCT interface service

Option 2

acute

Option 3

acute

Treatment of patient in PCTinterface service or hospital

Directory of S

ervices

Informatio

n included

The system is flexible –either

of these options is also possible

Proposed System

Patient GP

Option 2:PCT

Interface Services

Web basedDoS

SW LondonLIS

PCTInformation

National Guidelines

Option 1:Acute

Services

Option 3:Acute

Services

Choice

RiO/Booking Office

E referE book

Proposed GP process

GP Patient

Directory of ServicesDirectory of Services

RiO Electronic Booking System

RiO Electronic Booking System

PCT Back PainInterface Services

PCT Back PainInterface Services

Referral Letter

Referral Letter

BookingConfirmation

BookingConfirmation

InstructionsInstructions

Surgery Staff

BMS

EEMS Directory of ServicesHow is choice offered

Types of data held for each service includes:Types of data held for each service includes:

Service Information Service Information – e.g. who, where, what, – e.g. who, where, what, waiting times.waiting times.

Clinical InformationClinical Information – e.g. the description of – e.g. the description of the services being offered and clinical the services being offered and clinical referral guidelines.referral guidelines.

Practical InformationPractical Information – e.g. location maps, – e.g. location maps, patient information leaflets, car parking fees, patient information leaflets, car parking fees, Cobham Booking Office contact detailsCobham Booking Office contact details

PCT Back Clinic – Directory of Services

PCT Back Clinic – Directory of Services

PCT Back Clinic – Directory of Services

PCT Back Clinic – Directory of Services

E-Referral & E-Booking using RiO System

Find Clinic

FindAppointment

Book Appointment

Linking Booking, Choice Linking Booking, Choice Demand & EvercareDemand & Evercare

Using RIO (an existing system) to test e-referrals & e-booking processes for interface services

Developing PCT referral management centre & booking office - go live JulyExpanding/flexing flex diagnostic capacity- mobile equipment, PMS specialist for radiology

Expert patients – promoting self management, using collaborative

Using learning from Choice Using learning from Choice for demand managementfor demand management

Added value of Choice Patient has an informed debate Information for patients Clarity about implications of options “What and when” to “type of treatment”

Culture change Step change Getting used to electronic system Impact on consultation & practice processes

Bridging infrastructure gap between now and NPfIT