managing choice & demand linking access, booking, choice, demand management and evercare
TRANSCRIPT
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