Release 5.0 high level content

1. Release 5.0 high level content Expected release date Autumn 2010

2. R5.0 main changes • Support for the Appointment Slot Issue (ASI) process • Support for Alternative Care Pathways • Improved service search • Copying clinical terms

3. R5.0 minor changes • Referrer telephone contact details Referrer and registered GP Practice telephone number fields will be populated (if the data is held on the Spine Directory Service for that organisation) • Ability to record contacts on the Missing Referral Letters enquiry Ability for service provider users to record details of contact attempts (with a referring organisation) when chasing up overdue referral letters • Service Lifecycle Management Services that are transitioning to closure will not be available for shortlisting by referrers. Existing Unique Booking Reference Numbers (UBRN) with the transitioning service on the shortlist will be able to book, rebook and cancel their appointments

4. R5.0 minor changes contd. • Making rebooking comments visible before an appointment is made Improves visibility of information to support cancelling and re-booking appointments • Service provider visibility of UBRN after relationship has ended SP users will be able to see the history of UBRNs they have previously had a relationship with for 6 months from date relationship ended via the Patient Enquiry. Advice & Guidance responses will be available with no time limit • Removing request option (if appointment selected) Booking screen will not allow 'request' to be an option if an appointment slot has been selected • Enquiry totals Users performing a search will see a total of results returned and instructional messages on system enquiries

5. Support for the Appointment Slot Issue process

6. Current Appointment Slot Issue Process • When a Patient phones The Appointments Line (TAL), and is unable to book an appointment , the patient has the option to choose the Service they wish to attend. These instances are known as Appointment Slot Issues (ASIs) • ASIs are reported on a TAL report to all Service Provider organisations that subscribe to the ASI process, via email on a nightly basis • The Service Provider’s responsibility is then to book the patients that appear on the TAL report into appointment slots, preferably inside Choose and Book, but we know this is often done outside of Choose and Book • Meanwhile, the patient is advised to wait a set number of days to hear from their chosen service • The patient is also asked to ignore any reminder letters that they receive

7. Summary of changes • New process to enable users to put patient into ASI • New ASI worklist for Service Providers • New ASI Appointment Request Letter • New extract for Department of Health • New alert for users to check patients details are correct • Patient Web Application changes • Plus a couple of changes which will affect all UBRNs

8. Who can enter UBRNs into the ASI process? Following users can enter a UBRN into the ASI Process: • BMS Admin and BMS HCP Proxy (these users will work at an appointments line organisation) • Referring Clinician, Referring Clinician Admin, and Referring Admin • All service provider users processing an onward referred UBRN initiated from a service they are associated to, for example from a Clinical Assessment Service • All service provider users redirecting an inbound UBRN (i.e. via the change service functionality) • Patient (via Patient Web Application) Following users cannot: • All service provider users booking/rebooking an inbound UBRN (i.e. not via the change service functionality)

9. When can you enter the ASI Process? One or both of the following criteria needs to be met when searching for slots: • No slots are available at a service (user entered values on Appointment Search which limits slots do not count) • Technical slot errors occur when the user tries to book an appointment, i.e. Patient Administration System (PAS) doesn’t respond or the slot is unavailable

10. When can you enter the ASI Process? • Users can only enter UBRNs into the ASI process at services which experienced a slot issue • For example, if a service has available slots available to the user (ignoring user entered restrictions) the user cannot enter the ASI process at that service • An ASI cannot be initiated when the patient cannot find suitable slots

11. New appointment search screen Fig X. Appointment Search Screen New Defer to Provider button

12. Add Defer to provider alert New information message

13. Summary of short listed services showing which services may be deferred to Fig X. Deferral Options Details Screen Select one

14. Messages for User and patient to note.

15. View history action showing Deferred to provider status of UBRN

16. New provider ASI worklist

18. Actions available from the Provider ASI worklist • Book Appointment • Slot protection and slot reservation functions will be available to the service provider users to book ASI patients into • Cancel Request • Record ASI Contact • Add/Manage Additional Requirements • View Request • View History Note: As with current functionality, providers will still not be able to access the referral letter information until an appointment is booked.

19. Actions available from the Provider ASI worklist • New column on Service Provider Appointments for Booking and ASI worklists: • ‘Referral First Booked/ASI’ • Shows date of any initial/previous action against the UBRN (this may indicate an earlier waiting time start date) • Can be compared with date in ‘UBRN received’ column

20. New column on Appointments for Booking worklist

21. Column placement on ASI worklist

22. Example of new Appointment Request if referrer puts patient into ASI process

23. Date value calculation • The contact by date will be ‘X’ number of days from the date a patient’s chosen service is selected (i.e. the date when the UBRN appears on the Service Provider Appointment Slot Issues worklist) • ‘X’ number of days refers to the Priority of the UBRN based on the following defaulted values: • 2 working days for 2WW referrals • 5 working days for Urgent referrals • 10 working days for Routine referrals • For example, for a 2WW referral, if the UBRN appears on the ASI worklist on Thursday 14th January (i.e. day 0), the patient should be contacted by Monday 18th January (i.e. day 2). This date will be printed on the letter. Day 3 the entry on the worklist will turn red

24. Reminder Letter Suspension While a UBRN is in the ASI process, reminder letters will be suspended

25. ‘Deferred to Provider’ status • The status of ‘Deferred to Provider’ will be added to the following worklists: • Patient Activity List – in the Category column • Awaiting Booking/Acceptance worklist – in the Referral Status column • Two Week Wait Enquiry – in the Status column • Appointments for Booking worklist – in the Reason column  • Outbound Referrals worklist– in the Referral Status column  • Patient Enquiry – in the Referral Status column • Appointments Enquiry – in the Referral Status column

26. New Department of Health extract • Slot problems detected in slot searching sessions will be recorded on a new daily extract as they occur • A booking outcome will be recorded against each slot issue when the booking process is completed or abandoned • The extract will be a .csv file which will be sent to the Department of Health, and will include the following: • User • UBRN • Slot Issue Reason (no slots, slot unavailable, system unavailable) • Booking Outcome • Service ID and name • Service provider org • Specialty, Named clinician

27. Reporting changes • EBSX02, EBSX03, EBSX03a will record the ‘Defer to Provider’ and ‘Record ASI contact’ actions • SPR11 (Service Activity) report will have a new column – ASI – which counts when patient choice is recorded

28. Patient Web Application changes • New screens for the patient to enter the ASI process • New error screens • Re-numbering of steps to include the confirmation screen

29. New error screen on Patient Web Application

30. Clinic selection screen on Patient Web Application

31. Confirmation screen on Patient Web Application

32. Screen on Patient Web Application if patient tries to book UBRN again

33. Changes that will affect all UBRNs • New ‘Check Patient Details’ dialogue • The dialogue will only appear once for a UBRN within a given slot searching session • For users accessing the Deferral Options Details screen, the dialogue will only be displayed if the dialogue has not already been displayed in that slot searching session • Named Clinician displayed on Appointment Search screen

34. New alert for ALL UBRNs

35. Result of using Named Clinician filter in the Service Search screen

36. Importance of Change • Enables bookings to be kept within Choose and Book • Improved patient and referrer experience • Reduced time and effort to manage ASIs by providers • Reduces potential delays to care

37. Support for Alternative Care Pathways

38. Current process Commissioner is able to restrict access to Primary Care menu services by commissioning them as not available for initial referral. The service is only visible as an onward referral

39. Specified Change - Service Definition Changes: • Introduces the capability to make Primary Care Menu and Secondary Care Menu services restricted (i.e. unavailable for initial referral) for clinical reasons, or to support Practice Based Commissioning • Enables the provider of a restricted service to specify which services and individual clinicians or organisations may refer on to, redirect to and refer directly to their restricted service (authorised services, organisations and referrers)

40. 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 authorised 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

41. 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

42. Specified Change – Initial Referral • Changes: • Enables initial referrers to see restricted services and show them a pathway towards these services • Allows authorised individual referrers to refer directly to restricted services

43. 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.

44. 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 are authorised organisations. 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 Group Practice Restricted Service Authorised Service Authorised Organisation Key Newtown Surgery Newtown PBC Non-scalpel Vasectomy Service Dr Sweeting & Partners Fourways Surgery Village Health Centre New Lane Surgery Village Road Surgery Two Towns Group Practice Beech Grove Practice

45. Specified Change – Providing Information • Changes: • Provide new information about restricted services and why/how frequently they are restricted • Enhance extract EBSX05 and extract EBSX05a, to include information about restricted services • Enhance report COR05 and enquiry SPE08 to include information about restricted services • Provide new information about unpublished services

46. Importance of Change • The true definition of a clinical assessment service will be supported; i.e. only services providing the additional level of qualification and knowledge necessary to refer a patient on to a specialised (i.e. restricted) service will be able to do so • The current secondary care work-around (where services are labelled XXX HOSPITAL DO NOT USE and individual referrers are expected to observe this) will not be needed and the Directory of Services can be tidied up

47. Importance of Change • The changes will give the capability for multiple practices who are in the same practice based commissioning (PBC) group to refer into a specific service to which other referrers cannot refer • Initial referrers will be able to place their patient on the pathway towards the appropriate tertiary service • Visibility of restricted services will enable users to challenge any restriction they believe to be for non-clinical reasons

48. Importance of Change • Tertiary referrals will be supported i.e. the onward referral or redirection of a patient from a secondary care service to a more specialist service • Service providers will be able to publicise their restricted services by putting them on Choose and Book as they will be visible to Choose and Book users

49. Improved Service Search

50. Key points • Simpler search screen, more intuitive and logical flow following feedback post Release 4.2 • Improved service search functionality, introduces new capability to refine service search, e.g. IWT, place, location • Removal of redundant search criteria • The following service search will no longer be presented to the user on the Service Search Criteria screen: Due by Date; Problem; Problem Status; Requested Procedure