Facilitating Choose and Book

PRIMIS Facilitating Choose and Book Barbara Heyes (Barnsley PCT) Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future

BARNSLEY PRIMARY CARE TRUST Barnsley PCT PRIMIS Project Facilitating Choose and Book Barbara Heyes Information Facilitator

This session: • What is Choose and Book? • GP practices in Barnsley • Barnsley Early Adopter Project • Why PRIMIS facilitators? • PRIMIS and roll-out NB Only giving the Primary Care Perspective

What is Choose and Book? “Choose and Book is a national service that will, for the first time, combine electronic booking and a choice of time, date and place for first outpatient appointment. By the end of 2005 it will be available to all patients in England requiring elective care” GPs and patients will see which hospitals are available for each specialty, together with a list of available appointment slots. Patients can choose and arrange an outpatient appointment while at the practice. GPs will be able to choose a service and then, if they wish, hand over the completion of the booking to a colleague in the practice. Demonstration/Slides

Choose & Book - Process Changes • Booked appointment at time of decision to refer • Referral information retained in system • Reminders & confirmation regarding referral letter sent • Advice & guidance • Reports • Decision support • Electronic transfer of referral letter • Enables choice

Barnsley PCT • 44 practices • 38 EMIS LV; 1 IPS; 5 going to EMIS PCS • 8 practices in the Early Adopter Project • Planned10 live with CAB by end of May

Barnsley Early Adopter Project • Managed and run as a project – Project Board, Project Team • April 2004 – South Yorkshire Early Adopter for EBS based on readiness assessment • June 2004 – first live booking • December 2004 – effective go live • April 2005 EA status ended – roll-out • So far approx. 2 practices/month • May 1st over 250 electronic bookings (total bookings: approx 600 )

The Process Elements: • Clinical Engagement • IT infrastructure • RA process • Training • Referral letters • Workflows in Primary Care

Clinical Engagement • Communicate to all • Locality meetings - including clinical demonstration • Clinical ‘Champion’ • Select early implementers • Practice meetings to engage doctors and practice staff “sign up” • May take several visits

IT • Software: EBS & Spine; Hospital – McKesson PAS; EMIS • Infrastructure: No technology challenges – resource and organisational issues; Computer networks & PCs - which to upgrade/replace, printers • N3 • Smartcard – RA process • Readers (Java updates)

Training 2 elements: Choose and Book and Clinical System 1. Choose and book • Training Materials: simulation training; no specialist training or materials for helpdesk staff • Clinical Engagement: ensure training is flexible in approach for clinical staff/practice managers/admin • Time frame for training • Basic IT skills/TNA: Staff must have a basic understanding of IT skills to use the Choose & Book system • Role Mapping: Practice Managers and Hospital Managers required to have full involvement in deciding functional roles

2. Clinical system • Web based referrals: what information will be added? • Unique Booking Reference Number (UBRN) • Referral information (coded) and letter • Integrated referrals: problem title, Referral code (8H…), referral letter (pre-coded information + attachments)

Workflows • CAB presents 2 options: • GP does it all • GP makes referral and requests appointment • Barnsley PCT offers 3 options • GP does it all • GP makes referral and requests appointment • GP does nothing on CAB

GP Requests and Books appointment Access Choose and Book Search for the Patient Search for Services Request Appointment Book Appointment Print appointment Enter data on clinical system (problem title/UBRN) Generate/write referral letter

GP Requests appointment Access Choose and Book Search for the Patient Search for Services Request Appointment Appointment request printed Booking completed at the practice or through Booking Management Service or over the Internet Referral letter and data entered on clinical system separately

GP requests referral – someone else ‘does the IT’! Access Choose and Book Search for the Patient Search for Services Request Appointment Booking completed at: the practice or Booking Management Service or over the Internet • GP requests referral • informs Admin Staff • Admin staff use CAB Referral letter and data entered on clinical system separately

Referral Letters • Web-based (naked) booking Referral letters sent as attachments, therefore: • Develop standard PCT Referral letter templates for CAB clinics and electronic versions of pro-formas (e.g. RACPC) • May need Word Integration training – some of our practices still use the EMIS WP • 2. Integrated (end-to-end) booking • Referral letters start with a pre-populated form, therefore: • Need to make a decision about leaving boxes pre-ticked or un-checking some/all coded entries • Still need to send extra detail as attachments – standard letters • NB: Scanned documents, ECG/Xray/test results

Its been a challenge that I have enjoyed The training package was quite good, but its layout is poor and a bit “all over the place” Choice will be a nightmare It is more work for the practice, but it’s very good for individual patients Most GPs are fairly positive There was an inadequate appreciation of the training and work flows that was required to make the changes, not enough human resource was made available Flexible “can-do” attitude by everyone involved The implementation of C&B offers opportunities to break down communication barriers and agree care pathways across primary and secondary care Don’t be driven by external organisational targets – don’t roll out until ready The implementation of C&B offers opportunities to break down communication barriers and agree care pathways across primary and secondary care

Why PRIMIS? • Primary Care Facilitators need to be involved early in the process… knowledge of practices; looking at workflows helps identify CAB roles; assess wider training needs • Set in the context of clinical system usage • Data Quality issues • Referral letters

Current Working Practice • Practices work quite differently to each other & GPs within the same practice work differently to one another • How does the practice use IT to support the referral process? - applies to referral criteria, processes, letter creation,use of the clinical system • Practices have different priorities: new GP Contract (Quality and Outcomes Framework), special clinical interests, IT • CAB may be a huge cultural change And…… • There are still a number of GP practices that are in the process being computerised

Clinical System Usage • There is wide variation both nationally and locally in clinical system usage: look at current practices and see where there are gaps • There is wide variation in data quality: implications for all aspects of NPfIT • How is the information on the clinical system used for choose and book? practices protective of data, pressures of general practice, benefits of C&B? • Referral letters/clinical information: integrated letters use of clinical system data, helps secretaries! • Start early – see the bigger picture!

To maximise early clinical buy-in and begin usage the following are required: • An assessment of current working practices to develop … • a clear understanding of the roles and responsibilities of each user allowing … • training to be delivered in a consistent manner and tailored to individual users current working practices but … • within a framework to allow migration to new more efficient and effective working practices over time and with confidence

An assessment of current working practices • Can have centrally developed workflows, but need to work around an individual practice’s current working practices • Ask the secretary: how is a referral generated? How is the letter prepared (dictated/email)? How is it written? How is the data put on the system? Coded? • Ask the Practice Manager: how long are appointment times? How much is the computer used? How do the GPs use the system?

Develop a clear understanding of the roles and responsibilities of each user • And work together to find the best solution for the practice • Make sure the GP knows that as long as he/she requests the referral and writes the letter – someone else can make the request on Choose and Book (‘do the computer bit’) • Ensure all GPs in the practice know what services are bookable! • Find an enthusiast who would like to take a lead • Follow bookings through in the early stages – satisfaction of having happy patients

Allows training to be delivered in a consistent manner and tailored to individual users current working practices • Training is effective when the needs of individual users are understood • Help the practice identify training needs themselves – help them identify Choose and Book roles early • Use PCT staff who understand about General Practice, who understand about the need for data quality and for integrating use of the clinical system with CAB

Need to allow for migration to new more efficient and effective working practices over time and with confidence • How will you encourage a GP who won’t enter a BP (QOF payments) to make electronic appointments? • Set it in the context of using the clinical system to support patient care

Lessons Learned • Resources – need to spend time with the practice to get them live! • See training in the wider context – system usage • Need to work closely with IT & training - wasted time if the infrastructure isn’t in place and working • Keep up to date with developments – Communication • Practical support – develop standardised templates, referral request slips, workflows • Practices appreciate hands-on support for first bookings • Happy GPs with happy patients will encourage others to be enthusiastic

The Future? • Introduction of choice • Integrated systems – will change most things, what about • Clinical engagement? • Data transfer? • Referral letters? • System usage? • Demographic data? • DATA QUALITY

Barnsley PCT PRIMIS Tools • Written workflows with three options • Simple guide to role selection – drives smartcards, training, workflows, IT • Clinical system training: Word Integration, Referral Module; Consultation Mode • PCT centralised referral templates • Service Selection cards (updated monthly) • CAB shortcut on disk! • GP referral request slips • Checklists for Infrastructure and Go-live

December 2005:by December 2005 all patients who require elective care will be offered a choice of date, time and hospital (or service) at the point of referral. PCT PRIMIS Facilitator Happy GP and happy patients

Facilitating Choose and Book