Transcript Title of presentation - Welcome to the BHBT Directory

Choose & Book
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GP Registrars
Barking, Dagenham & Havering
Wednesday 9th January 2008
Urswick Medical Centre
Dr Richard Burack
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
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
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
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
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
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
For GPs
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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
For GPs
 Extra IT resources
 Funding for new spine compliant PC
 Secure logins / increased security
 Extra remuneration (C&B DES / LES)
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Component 1, offer choice (24p)
Component 2, 60% survey satisfaction (24p)
Component 3, Use booking system (24p)
Component 4, 90% UBRN conversion (24p)
Process of Clinical Engagement
Inside the clinician…
Choose and Book
GP/patient
Internet
Directory of
services
Appt.
reminders
Primary care
system
DNA
queries
Provider info
Commissioning
rules
CAB
Available
appt. slots
BMS
Booked
appt. slots
PAS system
Advice &
guidance
Referral letter
Consultant/patient
PCT
NHS change equation
Frustration with
the current situation
+
Advantages of where
we’re trying to get to
>
Perceived barriers to
the change
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
“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.”
Reactions to change
Rational
Political
Emotional
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
Perceived barriers…
Primary care
 Consultation length
 Information support
 IT issues - training / performance
 Staff capacity / resources
 Development of booking guidance (protocols)
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)
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
The GP does it all
Making the referral and booking the
appointment with the patient
Setting the scene
 Busy Monday morning
 10 minute appointments
 Dr Abbott has 18 patients to see in 2.5 hours
Authentication
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James Abbott
I think you need to
see a specialist.
Using the new
Choose and Book
service, we can book
an appointment for
you.
GP System: Patient details page
Choose and Book icon/button/function key
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
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
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
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
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
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
Advantages
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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
Advantages
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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.
C&B Disadvantages
 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
Disadvantages
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IT literacy from practice / secretary / GP
Pt compliance to be on spine
Time within consultation
C&B can be slow, slow/lengthen the consultation
How secure is the C&B / NHS spine
Service disparity depending on ability of NHS Trusts to
engage / link PAS systems
Disadvantages
 PCT govern the choice?
 Efficiency savings factor somewhere
 Linked to C&B DES, financial penalties for not
achieving targets
 UBRN conversions are at patient level, NOT practice
C&B – the future
 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
C&B – the future
 Patient choice, pt involvement, pt lead NHS, PPG influencing
commissioning decisions
 Linking up with PBC, primary care commissioning services
 Service re-design based on 18 week target pathways
 Service re-design based on being less than PBR tariff
 Carrot & Stick, financial implications are always a PCT method
of paying GPs, likely to continue
C&B – the future
 Meant to be a 2 way process, this could / should be developed
 Other ???