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CENTRAL CHESHIRE LOCAL HEALTH COMMUNITY Choose & Book Implementation Plan 22nd October 2004 PROGRAMME MANAGEMENT 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. COMMISSIONING FRAMEWORK AND CONTRACTING ARRANGEMENTS 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. SUPPORTING PRIMARY CARE CLINICIANS AND REFERRERS 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 meeting. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 1 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. DEVELOPING NEW WAYS OF WORKING 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. DELIVERING FULL BOOKING WITH CHOICE 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. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 2 MIGRATION TO ELECTRONIC BOOKING WITH CHOICE 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. INFORMATION AND SUPPORT TO PATIENTS AND CARERS 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 NHS.uk 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 realisation. Regular communication occurs with CCPCT‟s Trust Board and PEC. HUMAN RESOURCES 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 unions. 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 separate. 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. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 3 SECONDARY CARE MODERNISATION 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. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 4 APPENDIX I SUMMARY TIMESCALES FOR IMPLEMENTING E-BOOKING, FULL BOOKING & CHOICE Key Issue Lead Timescale Full Booking Compliance* 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 Knapman BMS Ready Debbie 31/1/05 Bywater 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 Danebridge Earnswood Review initial implementation Mark Wilde End Mar „05 D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 5 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 Swanlow Delamere 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 Medicine Oakwood Clinical Oncology Middlewich Rd Thoracic Medicine Nantwich HC Nephrology Watling St Riverside Scholar Green Acorns Kingsmead High St, Winsford 4 -5 Other hospitals have gone live with e- End Oct „05 100% booking and rolled out to all specialties Key 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 booked. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 6 APPENDIX II PROPOSAL FOR IMPLEMENTATION OF E-BOOKING AND ACHIEVEMENT OF FULL BOOKING AND CHOICE TARGETS 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 appointment 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 1 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. 2 Full booking is part of the key performance indicators of MCHT and counts towards their star rating. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 7 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 3 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 transferred. 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. 3 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 4 NHS Direct service specification currently does not include the offering of “choice”. 5 “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. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 8 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. D:\Docstoc\Working\pdf\b00cd86b-dccd-40c1-8c7a-57c4ed578337.doc Page - 9
"SECONDARY CARE MODERNISATION"