improvement in almost ‘real time’. The local performance report solely used the data, as it clearly identified e-RS and non-e-RS referrals received from each of the GP practices. of paper referrals already occurring, but if considering PSO and returning referrals with lower utilisation, this will be more labour intensive and so resource impact needs to be considered. 7 Data reporting Data reporting was supported through dedicated allocation and effective management and analysis by the provider booking manager. Assign dedicated time for data reporting and analysis to identify any specific areas for improvement. 8 Data reporting In preparation, the project team agreed early on to communicate to GPs what types of referral MUST be sent via e-RS, and what would be excluded. Note: PSO exclusions might not be exclusions to the MAR, eg. emergency clinics. Agree list of exclusions with CCG at earliest possible stage prior to go live pilot phase Review this on a regular basis in line with new services This task has been added to action plan in the development phase. 9 Data quality review Initial discussions during the project initiation phase focussed on data quality and project reporting to determine not only whether there were any data and reporting discrepancies, but also assist to identify the paper referrals still being sent to the trust. Strat data reporting ASAP, this can be done before the formal project start. Paper switch-off projects with a utilisation baseline of 80% and above, which will be starting full paper switch-off processes should focus on data and reporting quality as a first priority and at the initial phase of the project. All other projects should undertake data and referral PAS
reporting analyses (MAR and data) at an early stage of the project to correct any discrepancies and determine the base-line and necessary process for accurate reporting for the paper switch-off project duration. However, this is in conjunction with all other project objects and should not be the sole focus. 10 Data quality review We compared the booking data from e-RS against the corresponding booking data extracted from the SF-PAS. This was very time consuming and all it achieved was identification of data inconsistencies led to us focussing on one data source as already reported. Identify areas of data inconsistency in order to demonstrate margin of error on data reporting for monitoring ongoing PSO position, but don’t go into too much detail. MAR data needs to be accurate and that should be used as the guide. The key is to ensure that the information on e-RS needs to be correct, and if it is not on e-RS but should be, then get it on. Trust Performance/ Information Team are included in the PSO project, at least to support the initial data analysis. 11 Baseline e-RS position/ Preparation The trust had high usage of e-RS prior to the commencement of programme and good relationships had been built by central support officers with GP’s to support usage of e-RS Ensure that high usage of e-RS is in place prior to commencing the final PSO stage. One way of achieving high utilisation is to ensure there are good relationships between the provider and GP practices.
etc.), the clinic code should be identified. Where paper referrals are received into PAS clinics, the project team need to identify whether the clinic is mapped to and can be referred to via e-RS or not. Referrals will only be received via paper if the service is not available to the GP/practice on e-RS. 14 New operating processes / Access policies SFH and the CCGs developed new operating processes for the handling of referrals from 30 April to 31 May (transitional processes during pilot period) and 1 June onwards (post transition processes). These were signed off by the medical director of SFH and David Ainsworth (clinical rep. at the CCGs). This process was supported by having the centralised booking team as a resource for GP’s to email or telephone with any queries. In the pilot “switch-off” phase, the trust kept the paper referral in order to keep track that the referral still got made, and it matched up to one through e-RS. It took longer than expected to get appropriate clinical/executive to changes to policy and process. was a need to secure a comprehensive list of GP email addresses for rejection process and this took longer than expected to obtain. Allow sufficient time to ensure governance processes are agreed and signed off by CCG and trust governance leads i.e. algorithm, rejection process. Develop and agree local operating processes regarding actions should any paper referrals be received following PSO “go-live” and ensure these are approved by clinical representatives at both the provider and CCG. Communicate these to all GP practices. Keep of paper referrals following “switch off” to identify any specific GP practices which require further communication. .
The main reason identified for paper referrals continuing was due to high locum workforce but GPs try to refer back to them. GPs also report they feel more “confident” with the referral on paper. Key message for anything critical – use e-RS and then for anything urgent follow up on the phone/email to team. Communicate and reassure practices that referrals are not higher priority/seen quicker/less likely to be missed if they are on If they have any concerns the e-RS referral would be missed, advise practices to still use e-RS and follow up on the phone/email to team. 15 New operating processes / access policies It was not possible to achieve approval of the revised trust access policy by both trust board and CCG governing body before ‘go live’. Only relatively minor words changed but due to the review process being only every 3 months, plus the number of committees, this takes significantly longer. (Although this was not business critical for ‘go live’ in this particular situation as changes were minor). Revise and approve trust access policy prior to “going live” with PSO status. This needs to be right at the start of process due to all the approvals. National project plan revised to ensure this at the 16 CCG communications The CCG used a number of channels to reach practices, ie. weekly newsletter, direct telephone conversation, clinical exec committee. Some FAQ’s were also developed and shared based on GP practice queries Ensure that GP practices are communicated to early on in the project, regularly, and also consider direct communication to ensure they are aware of the revised process. Use as many different kinds of communication as possible to Added to implementation pack