CENTRAL CHESHIRE
                                          LOCAL HEALTH COMMUNITY

                                        Choose & Book Implementation Plan
                                                22nd October 2004


   Philippa Skaife- Jones is the named Executive Directors.
   Neil Borthwick is the designated Project Manger – Prince II trained. Rhoneen Schoneville and
    Mark Wilde are deputy project managers and form part of the project group with Neil.
   A PID has been produced and will be signed off once costings have been finalised.
   Multi-agency project board (SImP) has been established with StHA representation. SImP covers
    all workstreams e.g. e-booking, choice @ 6 months, referral management, etc
   Project plan has been produced and recently realigned (see attached summary – Appendix I)
    following clarification of deliverables from the National Programme and based upon Option A for
    achievement of the Choose and Book targets presented in Appendix II.
   CCPCT Chief Executive chairs the StHA Programme Board.


   Due to its geographical location the PCT already has activity contracts which will provide 4-5
    providers for most specialties.
   Services, e.g. renal, neurosciences, etc, which are commissioned via the StHA Specialist
    Commissioning team will not offer a plurality of providers.
   The PCT evaluates and monitors demand for services against the available commissioned
    capacity through the Capacity Planning process. There is an agreed in-year process for managing
    contract variances.
   The LDP which covers 2005/06 will consider all the issues highlighted in the state of readiness
    document (3.2 point 5) when it is delivered in March 2005. The local OSC is actively involved in
    the PCT commissioning decisions.
   The PCT is currently reviewing its full information provision.
   CCPCT has lead commissioning arrangements for all NHS Hospital Trusts, where contracts exist,
    with the other three PCT‟s previously part of South Cheshire Health Authority. These
    arrangements are currently under review.
   The PCT has a full PPI strategy.


   Launch day held to engage the clinical staff in the first six GP practices and the four specialities
    that will go live first.
   There is GP and Consultant representation on the Project Board (SiMP) and on the service
    subgroups. Service sub-groups link in with specialty networks and other areas with identified
    best practice. Regular updates on choice @ the point of referral are given to the monthly GP leads

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   The training subgroup has identified the most appropriate training location and times to suit the
    individual GP practices. Training to coincide with overall project timescales.
   The PCT is committed to evaluating the local impact that implementing Choose and Book on the
    GP practice workforce and where the workload can not be avoided look to resource it.
   The StHA is co-ordinating across the LHC‟s the development of referral pathways to support
    Choose and Book.
   Article on Choose and Book appeared in the “Reach” newsletter.
   Detailed engagement of individual clinicians has been difficult so far because of the ongoing lack
    of a comprehensive “hands on” system to show them.


   The LHC is still planning the mechanism for following up patients who do not book their
    appointment to avoid them becoming “lost”.
   Many care pathways have already been developed during the work to modernise booking
    practices. More care pathways / referral pathways will be completed by the cross LHC work
    currently being co-ordinated by the StHA. This LHC is leading on ENT and CHD.
   A full training programme is currently being developed to underpin the implementation of
    Choose and Book across primary and secondary care.
   Any reliance the LHC has upon the National Programme for IT has been identified through the
    risks log as part of the overall project management.
   The Booking Management Service is being commissioned from NHS Direct and will be within an
    arrangement covering the whole StHA. A lead PCT has been identified to commission this BMS.
   Initially our only proposed clinical management service is around Orthopaedics and it has been
    decided that if developed this triage and assessment service will be utilized before the choice of
    hospital provider is made to patients. A group with Consultants and other clinicians is developing
    this model and has investigated other models of best practice.


   The LHC fully intends to include primary care-based services as choices for patients where
    appropriate e.g. oral surgery / dental. This will be detailed and implemented in a subsequent
    stage of the project.
   The strategic approach of the LHC, to deliver full booking, is through the implementation of e-
    booking. As an e-booking “early adopter” we are timescaled as an LHC to have implemented e-
    booking by December ‟05.
   The LHC has a communications plan for choose and book and this will be checked with members
    of the general public and consulted on through the Scrutiny Committee.
   MCHT continues to work to change its clinic structure and processes and to review its workforce
    arrangements in preparation and on the timescales for the implementation of e-booking.
   The plan for delivering full-booking and choice with contingency arrangements is presented in
    Appendix II.

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   As an early adopter for e-booking the strategic approach of the LHC is to implement e-booking to
    achieve the targets in full booking and choice.
   With this strategy full adherence to Choice guidelines and timescales is dependent upon other
    LHC‟s implementing e-booking. We are identifying our key alternative providers to work with
    on e-booking systems.
   Alternative systems for delivering Choice and full booking are not being pursued because it
    would divert valuable resources away from implementing e-booking and would undermine the
    clinical engagement we are attempting to build around e-booking.
   However interim manual systems have been agreed to offer Choice in Cataracts and CHD which
    will be implemented to the national timescales.
   A summary of the project plan detailing the timescales for the implementation of e-booking, full
    booking and choice can be found in appendix 1.


   General information to patients has been outlined in the projects communications plan.
   The communications plan will be further revised to address the needs of hard to reach patients
    and communities.
   In the main, publications will be utilised from the Choose and Book website.
   The commissioned BMS from NHS Direct will have access to the information on which
    both the PCT and MCHT are committed to keep up to date. NHS Direct is well placed to support
    patients with hearing, language and other difficulties. National figures estimate that 80% of
    bookings will be made via this route.
   The PCT is currently working with GP‟s to grow their knowledge and confidence in providers,
    i.e. ISTC‟s, with whom they have no previous history.
   Feedback from patients is designed into the methodology for evaluating the projects benefits
   Regular communication occurs with CCPCT‟s Trust Board and PEC.


   The impact of e-booking on the current booking staff at MCHT along with those proposed who
    will book appointments in primary care will be assessed as part of the project.
   The PCT is committed to resourcing the workload e-booking puts into primary care.
   Both Directors of HR have been briefed on the likely impact e-booking will have on staff.
   Awaiting confirmation of the appropriate time to discuss the implications of e-booking with
   Training programme being developed for all staff groups on the e-booking software.
   Current staff induction processes in MCHT and CCPCT will be examined to ensure the
    authentication process needed for NPfIT initiatives are properly embedded as opposed to being
   To support Choice @ 6 months the PCT has a temporary contract with NHS Direct so that the
    transfer to the main BMS can be handled smoothly. No bank of PCA‟s to redeploy.

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Services are constantly being improved to improve patient access and the quality of care that is given.
Changes are implemented in secondary care as a consequence of joint work with primary care.
Previous sections of this report have referred to the production of care guidelines/pathways as part of
the Early Adopter programme for e-booking.

The following are examples of how services continue to evolve and develop:

        Agreement of care guidelines/pathways in specialties e.g. ENT
        Agreeing a programme with clinicians to implement e-booking across the Trust
        Continued reduction in the number of follow up outpatient appointments
        Production of Directory of Services
        Implementation and monitoring of policies on annual leave/study leave
        Appointment of nurses with a specialist interest in a variety of specialties
        Development of a new Treatment Centre
        Implementation of triage and treatment in orthopaedics

Secondary and primary care will continue to work together to implement service changes to improve
access for patients.

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                                                                                                 APPENDIX I

                             SUMMARY TIMESCALES FOR IMPLEMENTING
                               E-BOOKING, FULL BOOKING & CHOICE

 Key Issue                                                        Lead             Timescale     Full Booking
 EMIS Compliance                                                  National         30/9/04

 N3 connections                                                   Stuart Lea       1/11/04

 Install Software and Reader Hardware                             Stuart Lea       Underway

 Implement manual choice @ the point of                           Mark Wilde       End Nov „04
 referral system for cataracts
 Process of for Urgent and Cancer referrals is                    Rho              End Dec „05      18% *
 changed to bring opportunity for booking                         Schoneville
 within 24 hours
 ICS Compliance                                                   National         31/12/04

 Complete Directory of Services                                   Stuart Lea /     13/1/05
                                                                  Neil Borthwick
 Protection of PAS slots for e-booking                            Neil Borthwick   13/1/05

 Registration Authority                                           Stuart Lea       13/1/05

 Training staff                                                   Jackie           13/1/05
 BMS Ready                                                        Debbie           31/1/05
 Local ICS compliance testing & configuration                     Neil Borthwick   18/2/05

 1st Stage of e-booking go live                                   All              End Feb „05      11.9%

  Practice                       Specialty
  Ashfields                      General Medicine
  Mere Park                      Orthopaedics
  Willow Wood                    ENT
  Oaklands                       Ophthalmology
 Review initial implementation                                    Mark Wilde       End Mar „05

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 2nd Stage of e-booking go live                                   All            April „05        42.5%

  Practice                       Specialty
  Brookland House                General Surgery
  Grosvenor                      Dermatology
  Mill Street                    Gynaecology
  Kiltearn                       Obstetrics
 Implement manual choice @ the point of                           Mandy Donald   April „05
 referral system for CHD                                          / Mark Wilde
 3rd Stage of e-booking go live                                   All            End Jun „05      69.5%

  Practice                    Specialty
  Hungerford Rod              Urology
  Cedars                      Paediatrics
  Weavervale                  Oral Surgery
  Weaverham                   Rheumatology
  Haslington                  Pain Relief
  Launceston Close            Clinical Haematology
  Castle                      Orthotics
  Beam Street
 4th Stage of e-booking go live                                   All            End Sept „05**   86.64%

  Practice                    Specialty
  Witton St                   Genitourinary
  Oakwood                     Clinical Oncology
  Middlewich Rd               Thoracic Medicine
  Nantwich HC                 Nephrology
  Watling St
  Scholar Green
  High St, Winsford
 4 -5 Other hospitals have gone live with e-                                     End Oct „05      100%
 booking and rolled out to all specialties

Shaded areas indicate “key issues” on the critical path for the initial go-live date of 21/2/05.

* - Subsequent percentages do not take into account the cancer and urgent referrals being fully

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                                                                                                          APPENDIX II


It has become clear that to achieve the NHS targets of 100% Choice and Full Booking1 2 in December
2005 we have to change the current booking processes. There are two options on how we can do this.

      a.       To implement the e-booking system before other hospitals PAS‟s become compliant with
               the Choose and Book software.
      b.       Introduce a booking process which is different to the current and proposed e-booking
               system and based on e-mailed referrals.

Option (b) is viewed as less desirable because of the duplicate time and resources needed to
implement any interim system prior to e-booking. There are also concerns whether any system under
option (b) could authenticate that the person ringing to make a booking is the right patient and that
they are booking into the right consultant / specialty.

Option (a) to implement e-booking implementation ahead of many hospital PAS‟ becoming
compliant is therefore the option we are currently pursuing:-

    Option (a)
                          3. Patient
                          leaves GP
                         practice and
                         rings BMS                                                  5a. MCHT
                                                                                    booked via e-
                      2. Appointment                      4. Patient                booking system
     1. GP                request                       authenticated
    decides           generated from                     and offer /                            OR
    to refer             e-booking                       decision of
                           system                       choice made                 5b. “Direct
                                                                                    referral”, made in
                                                                                    e-booking, to other
                                                                                    hospital & patient
                                                                                    call transferred to
                         Referral                          Referral                 their booking
                      generated on e-                    accepted by                service
                      booking system                      consultant

  Full booking is defined as the patient having the ability to book their hospital appointment within 24 hours of a decision
being made to refer them.
  Full booking is part of the key performance indicators of MCHT and counts towards their star rating.

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A more detailed plan of the above pathway for option (a), including contingencies, is: -

     Patient Journey                         Action
    1. Decision taken to refer               GP launches e-booking software from EMIS

    2. Patient given UBRN from               GP generates UBRN on e-booking software
       on e-booking software
                                                    NHS Direct                      Local BMS

                                             4. Authentication                4. Authentication
    3. Patient calls the BMS                 gained from UBRN                 gained from UBRN
                                             All hospitals have               Manually produced
                                             pre-populated the                DOS
                                             Directory of services

                                             Choice of provider           Choice of provider
    4. Offer of Choice made to               discussed &                  discussed &
        patient                              explained 4                  explained
    5a. Booking made to MCHT                 Booking made              OR Booking made
                                             through the e-               through the e-
                                             booking software             booking software
    5b. Booking made to other                “Direct referral”            “Appointment
        hospital                             made to other                request details” from
                                             hospital5                    e-booking system to
                                                                          be printed and faxed
                                                                          to other hospital
                                             Patient told to either       Patient‟s call is
                                             call the hospitals           transferred to the
                                             booking service or           hospitals booking
                                             their call is                service

Locally Choice is expected to be introduced by GP‟s but, in most circumstances, is not then expected
to be offered by the GP (or in their practice). Therefore separate e-booking and e-mail referrals
systems will not be mutually compatible because the GP is not aware of which hospital the patient
has chosen to go to and hence which referral / authentication system to use. Option (b) would
therefore require our local health community to withdraw from being an early adopter for e-booking.

  Dependent upon e-booking software suppliers giving approval for hospitals to create a DOS ahead of them going live.
Release 2 is available in Spring „05
  NHS Direct service specification currently does not include the offering of “choice”.
  “Direct referrals” is an amendment to the e-booking software which has not yet been formally agreed and which might
be scheduled for release 3 (Sept ‟05). The precise detail of “Direct Referrals” in process terms needs to be more firmly
understood locally.

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Option (a) is the preferred option to achieve the full booking and choice targets by December ‟05.
Ideally the BMS would be provided through NHS Direct to avoid a full additional cost being incurred
in commissioning a local BMS (perversely also likely to be from NHS Direct). Contingency plans
are being drawn up for a local BMS if NHS Direct can not provide the required service for this
interim period due to the factors given in the footnotes on the previous page. If these factors could be
overcome and NHS Direct could be commissioned to provide a flexible service for the interim period
this has the potential to form the backbone of an interim solution across the StHA.

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