Offering Access and Enabling Choice using Choose and Book Allied Health Professionals Event South Ce - PowerPoint PPT Presentation


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Offering Access and Enabling Choice using Choose and Book Allied Health Professionals Event South Ce


1. Offering Access and Enabling Choice using Choose and Book. Allied Health ... All clinicians within department review referrals on line on a rota basis ... – PowerPoint PPT presentation

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Title: Offering Access and Enabling Choice using Choose and Book Allied Health Professionals Event South Ce

Offering Access and Enabling Choice using Choose
and Book Allied Health Professionals Event South
Central SHA 25 February 2009
Offering Access Enabling Choice Using Choose
Objectives for the day CFH Context Challenges
Influence Preparation Engagement
High quality care for all NHS Next Stage Review
final report
  • Raising standards
  • Stronger involvement of clinicians in decision
    making at every level of the NHS
  • Fostering a pioneering NHS
  • Help to stay healthy
  • Empowering patients
  • Most effective treatments for all
  • Keeping patients as safe as possible

Quality at the heart of the NHS
  • Empowering frontline staff to lead change that
    improves quality for patients
  • Valuing the work of NHS staff

High quality care for all
High quality care for patients and the public
Freedom to focus on quality
Health record securely accessible to clinicians
and patients
Share information securely with partners
Delivering better, safer care Quality at the
heart of the NHS
Information available at the point of care
Personalised wellness support for patients
Improving clinical quality and safety
Empowering patients and the public. High quality
care for patients and the public
Empowering staff to improve NHS
performance. Freedom to focus on quality
Public access to health information
Improving performance management
Public access to service implementation
Improving information for staff
Information to support high quality care
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Key delivery systems
  • Care Records Service SCR EHR
  • Choose and Book
  • Picture Archiving Communication System
  • HealthSpace
  • NHSmail
  • NHS Choices

Supporting work streams
  • Access Controls
  • Card Management
  • Record visibility and legitimate relationship
  • Secondary Uses Service
  • Clinical Content
  • SNOMED (Clinical Terms)
  • Dashboards

Clinical Dashboards
Locally tailored information, combined with
national benchmark metrics
Integration of multiple data sources, relevant to
multidisciplinary teams
Information presented clearly, with visual impact
Real time updates, assisting immediate, targeted
decisions and improved data quality.
Prototype summary AE (Homerton)
Uses AE department system covering Majors /
Minors / CEA / PUCC In use throughout AE
department, on public display, and in clinicians
Data Sources PAS and radiology feeds (every 10
minutes) London Ambulance Service (hourly)
Secondary Uses Service SUS
Information Data Standards Programme
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Choose and Book
  • AHP services from 1st April 08
  • Direct and Indirect Booking capabilities
  • Over 11 million bookings
  • Used by over 90 GP practices
  • Supported by the Personal Demographic Service
    (PDS) processing almost 50 million transactions
    in a typical month.
  • PDS replaces the NHS Strategic Tracing Service
    the 31st March 2009.
  • Bookable through my HealthSpace
  • Informed through NHS Choices

AHPs Preparedness
  • Develop the infrastructure
  • Integrate activity Information
  • Standardised Clinical Recording
  • Share current engagement
  • Understand the opportunities
  • Develop utilise networks

Overview of End to End Process
End-to-end booking (indirect)
End-to-end booking (direct)
Demonstration using Unplugged - From a referrer
perspective - From a provider perspective
End to end process Assessment Service
Assessment Services
My Experience of using Choose and Book
  • Graham Croker National Clinical Lead

Clinical Assessment Service models
  • Referral letter reviewed (Review of Referral
    Letter CAS) In this type of CAS, the CAS
    clinician simply adds their expertise to the
    assessment of the referral information provided
    by the GP and the patient is then referred on or
    advice returned to the GP. This style can be used
    for diagnostic services where the diagnostics are
    delivered as day-case appointments.
  • Telephone Consultation (Telephone CAS) A
    telephone CAS operates by taking referral
    information and then using a telephone
    conversation with the patient to gain additional
    information for the assessment.
  • Patient physically seen (Face-to-Face CAS) In
    this model, the patient is physically seen and
    assessed by a clinical specialist at an allotted
    time. The patient is then referred to another
    service or the advice sent back to the patients
    GP to assist with management.
  • Patient physically seen and diagnostics/
    treatment arranged (See and Treat CAS) This
    differs from the Face-to-Face CAS in that the
    clinicians or team that provide the assessment
    may also perform some diagnostics and treat the
    patient. Often these services are called
    Clinical Assessment and Treatment Services (CATS)
    / integrated Clinical Assess and Treat Services

Who is doing what now
AHP Bookings
AHP bookings by Provider
Data for Early Feb 2009
13,821,173 total bookings to date
Approx 25,000 outpatient bookings per day (26th
Jan 33,494)
80 of bookings are DBS
56 of referrals are made via CAB
90 of GP practices used CAB last week
Recent booking activity
Appointment activity
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Choose and Book in South Central SHA
  • Sue Allan, CAB Choice Lead SC SHA
  • 25 Feb 09

  • How are we doing with CAB in SC?
  • How does this compare to the national picture?
  • Issues affecting utilisation
  • Drivers for improving uptake
  • Progress in publishing AHP services
  • How do we take this forward / next steps

South Central progress
  • January utilisation 53, compared with national
    picture of 58
  • PCTs in SC range from 24 to 90
  • Mixture of direct and indirect booking
  • Mixture of processes from GPs using system
    directly to referral centres processing on their
    behalf although aim is to move away from this
    method to support patient choice

Issues affecting utilisation
  • Ability to do direct booking
  • Due to delays with National Programme for IT
    several trusts in SC have not been able to offer
    directly bookable services. Situation improving
  • Appointment Slot Issues
  • Where DBS sites do not make enough slots
    available to CAB and patient/referrer is unable
    to book an appointment
  • GP uptake CAB historical reputation issues
  • Still work to do in some areas to re-engage GPs

Drivers for improving uptake
  • Patient Choice/NHS Constitution
  • CAB main vehicle for supporting the ability of
    referrers to identify options and offer choice to
  • Legal duty on PCTs to ensure Choice is offered
    for elective referral to first consultant
    outpatient services
  • Start of 18w pathway, quickest route for booking
    and transfer of referral information
  • Clinical use of system to review, accept, reject
    referrals more efficient process
  • 1 system for making referrals ease of use for

AHP progress
  • Not good yet across SC but…..
  • Milton Keynes General has Dietetics services on
  • Started last Autumn
  • All clinics available to CAB, all IBS, booked via
    central booking office
  • Need to ensure clear mapping of CAB clinics to
    PAS clinics
  • All clinicians within department review referrals
    on line on a rota basis
  • Referrals mainly generic to aid this
  • Initial confusion in some areas but feedback and
    communication with referrers has resolved early
  • On the whole going very well - wish consultants
    in the trust could use to refer to dietetics too!

How do we take this forward in SC?
  • Learn from today what can CAB do for you?
  • All PCTs have CAB leads do you know them?
  • SC CAB user group meets monthly new users
    always welcome
  • How can CAB support your business processes?

  • Choose and Book is not about implementing an IT
    solution but enabling a business change …

  • Sue Allan
  • 07825 448195

AHP Clinical Terminology on Choose and Book
Specialties and Clinic Types
  • Specialties and Clinic Types have to be used
    together to find services to refer to
  • Specialty is a coarse filter
  • Clinic Type is a fine filter and should
    describe a group of conditions / problems will
    vary according to specialty
  • Currently 51 Specialties and typically between
    1-14 Clinic Types per Specialty
  • Worked with NCRP representatives for AHP
    specialties to derive the current AHP Specialties
    and Clinic Types
  • Revisiting all Clinic Types

Clinic Types
  • Clinic Types are used as a fine filter on CAB.
    They help to produce a more specific and relevant
    set of services for a patient, from which it
    should be easy for referrers to shortlist the
    correct ones.
  • Each CAB service can be linked to one or more
    Clinic Types within a single CAB Specialty
    Diagram on next slide
  • Even though providers can allocate more than one
    Clinic Type to a service, referrers can only
    select one Clinic Type for their service search.
  • The National Choose and Book team, with input
    from members of the National Speciality Reference
    Group (NSRG), ensures that the available Clinic
    Type names adequately reflect groupings of
    services used within provider organisations, and
    that they are meaningful to referrers.
  • We would like your involvement to ensure that CTs
    in AHP Specialties are correct

Relationships between entities
Mapping guidance
  • The more specialised services should typically be
    mapped to a single Clinic Type whereas more
    generalised services should typically be mapped
    to most of the Clinic Types within a CAB
  • General services may in addition be mapped to the
    Not Otherwise Specified (NOS) Clinic Type i.e.
    if the service covers more than is described by
    the other specific Clinic Types alone or in
  • General Services should not be mapped to the NOS
    Clinic Type alone (unless there really are no
    other suitable Clinic Types to map to) as
    referrers will be trained to only use the NOS
    clinic type if none of the other specific Clinic
    are suitable and hence will not be able to find
    general services only mapped to NOS.

AHP clinical terminology - review
  • Met with AHP leads on 11 November 2008 to
  • provide an update on Choose and Book
  • suggest a thorough review of clinical terminology
    with more involvement from the Specialty groups
  • Specialty Leads have made suggestions /
    refinements for comment at these workshops
  • More art than science!
  • Remember Clinic Types should first and foremost
    be meaningful to referrers secondly, they should
    help you to manage a streamlined pathway

Current Specialties and Clinic Types
Current Specialties and Clinic Types
New Specialties and Clinic Types
SNOMED Systemised NOmenclature of MEDicine
  • This is the key development arising from the
    Finding Services Effectively project conducted in
  • SNOMED is the clinical terminology system for
    Care Records Service
  • R4.0 made SNOMED functionality available to
  • Providers initially informed via Communiqué not
    to start assigning SNOMED terms to services
    until a pilot project had been conducted
  • Refinements to the pool of SNOMED terms (to make
    them more GP appropriate) and significant
    Specialty / Clinic Type changes have been made
    prior to implementation
  • Providers will be trained in February and March
    and will start loading SNOMED subsets early 2009
  • R4.2 will make SNOMED functionality available to
    referrers implementation date still to
    confirmed but probably June 2009

Common misunderstandings
  • SNOMED is not a new terminology system that needs
    to learnt by CAB users it is intuitive
  • Although all terms are coded, users will be
    working with common words and phrases that
    predominantly relate to conditions
  • SNOMED does not require a change to the coding
    systems with which staff are familiar in primary
    or secondary care
  • There is already a mapping to Read and ICD-10 /
  • Referrers will not be forced to search using

How will SNOMED work with CAB?
  • Each Clinic Type is associated with a set of
    SNOMED Clinical Terms (known as a subset) which
    contains all the relevant findings / conditions /
  • When services are defined, they are mapped to one
    or more Clinic Types this enables a Service
    Definer to apply appropriate SNOMED subsets
  • Providers can fine-tune which Clinical Terms are
    associated with their services (i.e. add and
    remove terms)
  • Referrers will be able to search for services
    which are associated with a clinical concept
  • As now, further information about listed services
    is provided by the Service Name and within the
    service details

New referrer screen initial display
N.B. The next few screens will not be available
until June 09
Using the CAB SNOMED browser
Selecting the right concept
The results of a service search
Current SNOMED terms for AHPs
NHS Choices and AHP Services
Free Choice
  • Allied Health Professional services currently
    fall outside of the scope of Free Choice Policy,
    as this is restricted to patients being referred
    for a first (medical) consultant-led outpatient
  • Implications of exemption
  • Can choose to put services on primary or
    secondary care menu
  • Primary care menu services must be commissioned
    in order to be visible
  • Secondary care menu visible to all
  • All services on the Secondary care menu are
    visible on NHS Choices
  • NHS Choices is a patient facing web application
    that provides them with information on available
    services and allows them to compare service

NHS Choices home page
NHS Choices - Provider search result
NHS Choices - Provider Treatments offered
NHS Choices - Treatment Detail
NHS Choices - Healthspace
Self Referral
  • In October 2008 the DH supported an initiative to
    enable AHP services to move towards self referral
  • Self referral doesnt currently fit with the
    Choose and Book process which requires a GP to
    generate a Unique Booking Reference Number
  • This has been raised with the CAB Medical
    Director for consideration
  • However NHS Choices allows the detail of services
    to be visible to patients they could then
    contact the service directly

Pre-requisites of loading a service on Choose and
Directory of Services webpage
  • This page provides key information on all
    elements of a Directory of Services as well as
    the Directory of Service entry template
  • Key requirements of all DoS entries
  • NACS code
  • Smartcards with appropriate roles (Service
    Definer, Service Provider Clinician, Booking
  • Agreed referral management process

Choose and Book Step by Step
Choose and Book Step by Step
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Choose and Book Step by Step
Options for IBS
Choose and Book Step by Step
Choose and Book Step by Step
Choose and Book Step by Step
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Many thanks Any Questions? Queries should be
sent to