Choose & Book

1. Choose & Book • GP Registrars • Barking, Dagenham & Havering • Wednesday 9th January 2008 • Urswick Medical Centre Dr Richard Burack

2. What is it? • Since summer of 2004 in England • Answered the research showing patients wanting to be more involved in choosing their healthcare, making decisions

3. What is it? • Works via a web-based programme • Pt needs to have their data / details / demography matched with the National Spine to work properly • First OP appts only, specialist care only

4. Is it working? • > 5 million referrals since inception • First 2 years before 1st million • < 1 yr to get the other 4 million • 88% of GP practices in England • > 15,000 referrals daily • 45% of total NHS referral activities from GP to specialist

5. Is it working? • Reduction in hospital DNA rates • Doncaster NHS Trust found a 60% drop in DNA rate • Kettering & Ashford NHS Trusts, 33% reduction in DNA rate • Decreased waiting times • 18 week target / pathway for patients met easier

6. For patients • Patients can choose form at least four hospitals • Patients can also choose the date and time of their appointment • Patients experience greater convenience and certainty • More secure, less chance that information is lost

7. For patients • Plan and manage around existing appointments • Fit their treatment with other commitments, home and work • Choose appointments that fit with their carer’s schedule • Check status of their referral, can change or cancel their appointments over the phone / internet easily

8. For GPs • Clinical Engagement • Possible reduction in non-clinical appts • Possible reduction in non-clinical time • Full directory of clinical services available • Immediate on-line booking, UBRN met

9. For GPs • Extra IT resources • Funding for new spine compliant PC • Secure logins / increased security • Extra remuneration (C&B DES / LES) • Component 1, offer choice (24p) • Component 2, 60% survey satisfaction (24p) • Component 3, Use booking system (24p) • Component 4, 90% UBRN conversion (24p)

10. Process of Clinical Engagement Inside the clinician…

11. Internet Appt. reminders DNA queries BMS Commissioning rules PCT Directory of services Provider info CAB Available appt. slots Booked appt. slots PAS system Advice & guidance Referral letter Choose and Book GP/patient Primary care system Consultant/patient

12. NHS change equation + Advantages of where we’re trying to get to Frustration with the current situation > Perceived barriers to the change

13. Frustration with current situation • System based on the convenience of the service not the patient • Inefficient with multiple steps (30 – 40) • possible errors ( eg missed referral letters) • expensive • Limited choice • Difficult to track what is happening and if it goes wrong very difficult to see where ( lack of an audit trail) • Difficulty accessing information about available services • Difficult to support protocols / guidelines / templates

14. “As I hope you are aware, a significant number of GPs involved in ‘choose & book’ pilots have found it to be most unsatisfactory and time-consuming. Furthermore, the so-called ‘choice’ is no more than the PCT following a political diktat, and was roundly condemned at our LMC meeting.”

15. Reactions to change Rational Political Emotional

16. Resistance Why should clinicians resist choose and book? • A feeling that is threatens something of value • A misunderstanding of CAB and its implications • A belief it doesn’t make sense clinically • A low tolerance for change - politics • Another ‘more for less’ initiative

17. Perceived barriers… Primary care • Consultation length • Information support • IT issues - training / performance • Staff capacity / resources • Development of booking guidance (protocols)

18. Perceived barriers… Secondary care • Patients will be booked into clinics before consultants prioritise referrals (Loss of control) • Risk of fragmented care • Consultants will gradually develop common ways of working • Impact of financial flows (PbR, practice based commissioning, choice)

19. Working with resistance • Anticipate and plan for it • View it as a natural process and a sign that you are engaging • Support people in expressing resistance • Take your time • Don’t take it personally

20. The GP does it all Making the referral and booking the appointment with the patient

21. Setting the scene • Busy Monday morning • 10 minute appointments • Dr Abbott has 18 patients to see in 2.5 hours

22. Authentication 1234567891000 James Abbott

23. I think you need to see a specialist. Using the new Choose and Book service, we can book an appointment for you.

24. GP System: Patient details page Choose and Book icon/button/function key

43. The advantages for the GP • Simple referral process • Full directory of all the secondary care services available • Decision support information for referral • Advice and guidance facility • Fewer queries from patients chasing referrals

44. C&B Advantages (Grp 1) • Spend 10 minute discussing the ‘advantages’ of having C&B as a service for Pts, offered by GP • Advantages from the Pt perspective • Advantages from the GP perspective • Include good / positive possible outcomes from C&B

45. C&B Disadvantages (Grp 2) • Spend 10 minute discussing the ‘disadvantages’ of having C&B as a service for Pts, offered by GP’s • Disadvantages from the Pt perspective • Disadvantages from the GP perspective • Include problems possibly encountered in implementing C&B nationally

46. C&B – the future (Grp 3) • Spend 10-15 minutes discussing the positive potential for C&B in the future NHS • Where could C&B take ‘us’ • What uses could it afford to Primary Care / NHS service provision for the Pts • Impact on other areas within the modern NHS, 18 wk waits, IMT DES etc

47. C&B Advantages • Spend 10 minute discussing the ‘advantages’ of having C&B as a service for Pts, offered by GP • Advantages from the Pt perspective • Advantages from the GP perspective • Include good / positive possible outcomes from C&B

48. Advantages • Greater opportunity to influence the way they are treated by the NHS • Ability to discuss their treatment options so that they experience a more personalised health service • Greater convenience and certainty reducing the stress of referral • Choice of a place, date and time that suits them, enabling them to fit their treatment in with their life, not the other way around

49. Advantages • Reduced anxieties of waiting for their appt • Patient focussed service provision • Increased referral security • Reduction in DNAs • Reduction in non-clinical primary care consultations • Reliable and comprehensive clinical information

50. Advantages • Reduced anxieties of waiting for their appt • Patient focussed service provision • Increased referral security • Reduction in DNAs • Reduction in non-clinical primary care consultations • Reliable tracking of booking, reduction in admin time on the paper chase etc.