Setting up and Running Clinical Assessment Services in Choose and Book Kallie Heyburn 18th January 2

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Setting up and Running Clinical Assessment
Services in Choose and BookKallie Heyburn 18th
January 2007
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The Musculoskeletal ICATs Model - Rationale

• Improving patient care by offering local services
  and improving outcomes earlier within treatment
  pathways
• Linked to national guidance through the
  development of the musculoskeletal services
  framework and the 18 week target
• Managing the demand of referrals into secondary
  care by redesign of care pathways
• Reducing duplication of referrals
• Developing a multi-disciplinary service
  encouraging closer working between Orthopaedics,
  Rheumatology and Chronic Pain

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Following Agreed Care Pathways eg Hip Knee
Return to GP with advice
Direct Access to Diagnostics
INTEGRATED CLINICAL ASSESMENT SERVICES (incl. EHA
linked to surgery listing) TRIAGE ALL REFFERALS
GP REFERRALS (via Choose and Book)
Rheumatology
Out patient Referral via CAB
Chronic Pain
GPSI, ESPs, Specialist Nursing etc
Orthopaedics
Primary Care services (ESPS, Physio, Chronic
pain, specialist nurses)
Referral made within 24 hours
Assessment completed within 72 hours
Outcome bookable within 6 weeks
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Referrals into ICATS

• Ashford 480
• 75 referred on to secondary care 16
• Dover 207 (from Sep 06)
• 30 referred on to secondary care 15

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Setting up the referral process via Choose and
Book

• Completion of service definition template
  clinical input
• RAing key staff and issue of smart cards
• Input service details on to DOS
• Commissioning of service(s)
• Initiate test referrals from Primary Care and
  onward referral into Secondary Care

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Setting up the referral process via Choose and
Book - continued

• Rolling out training to bookers and health
  professionals
• Reinforcing choice message for onward referrals
  to secondary care
• Agree go live date
• Communication out to referring clinicians
• Review processes dependent upon feedback from all
  users

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Process for booking 2 models

• Indirectly bookable
• Patient contacts service provider(s)
• Referral Management Centre

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Key challenges overcoming them

• Provider training and support
• Partnership working with local secondary care
  provider and sharing resources

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Benefits

• Streamlines referral process across the pathway
• Provides audit trail
• Supports choice and booking targets - 16 onward
  referrals
• Supports development of Primary Care models of
  care ensuring patient is seen in the right
  setting by the right health professional at the
  right time

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Secondary Care CAS Urology Triage

• Rationale
• Complicated pathway
• Referral letter needs to be reviewed before
  patient books an outpatient appointment
• High number of rejected referrals (60)
• Patient dissatisfaction
• Frustration within Primary and Secondary Care

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Setting up

• Discussions and agreement with key stakeholders
• Develop referral model based on current processes
• Agreed pilot areas and set review date
• Communicate out to all users
• Set up on DOS (as per Primary Care model)

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Process for Urology Triage Pilot

• GP uses Choose and Book to identify Choice
  Options for Patient and initiates referral on
  Choose and Book (obtains the UBRN)
• GP produces referral letter for the referral in
  their normal way and loads onto Choose and Book
  within 2 days.

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Process for Urology Triage Pilot - continued

• Patient makes Choice of Provider as EKHT (this
  may be during the GP consultation, or later via
  the Appointments Line or internet).
• Patient books appointment with the Urology Triage
  Clinic. They are booking an appointment for a
  phone call from the Urology Team after their
  referral letter has been reviewed. The
  appointment needs to be within seven to ten days.

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The process at EKHT Urology

• Urology Diagnostic Triage Team access Referral
  details on Choose and Book
• Letter is reviewed and team decide care pathway
• Outpatient Team phones patient at booked time to
  inform patient of the outcome of the review

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Possible Outcomes of the Review

• Patient needs Diagnostic prior to appointment
  with Consultant
• Patient can be seen by the consultant (will be
  able to book the appointment during the telephone
  call)
• Patient can be seen by non consultant specialist
  and patient will be booked within the Trust into
  this clinic as not on DoS
• Patient does not need an appointment letter of
  advice sent to GP and the referral will be
  rejected with reasons.

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Where are we now?

• Still relatively new but paving the way for
  future roll out to other Primary Care services
  and triaging of Secondary Care services

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Any Questions?