How CCAS benefits patient access and experience New clinical - - PowerPoint PPT Presentation

• How CCAS benefits patient access

and experience

• New clinical analysis

reporting

How CCAS benefits patient access and experience

• CCAS set up in 2007
• Aim is to improve the quality of referrals in Camden and support practices and their patients with the e-Referrals (formerly

Choose & Book) process

• Processes non-urgent referrals only
• GP Assessors provide advice and feedback to GPs on possible alternative management treatment plans
• Knowledge of local services where a patient can be seen sooner and/or more locally.
• Quality checks referrals.
• Avoids patient going through process of booking an appt. with a hospital, organising a time and date they are able to

make, which may end up being rejected by the hospitals and having appointment cancelled if the referral does not contain the required information and level of detail.

• Contacts patients to discuss choice in booking their 1st secondary care appointment and helps them if issues arise i.e.

providers cancelling appointments, no appointments available etc.

• All patients are contacted within 5 working days of receiving their referral - initially by phone, and if unsuccessful a letter is

sent, followed by a further phone call and letter 2 weeks later.

• Communicates with the Acute Trusts to understand their outpatient booking issues, cancelled clinics and excessive waiting

lists.

• Produces data to support the CCG in understanding trends and unusual levels of activity on an ad-hoc basis. This provides

the Commissioners with information about provider performance which can be addressed in Contract Review Meetings.

What Does CCAS Do?

• Hospitals are struggling with capacity which means that often there are no appointments available to book

immediately.

• Hospitals are supposed to deal with these but CCAS finds they do not respond as quickly as they should.
• CCAS checks each morning for appointments and chases up the hospitals to make sure they are dealing with these.

CCAS dealt with 2,896 patients in 15/16 in a centrally located list of all waiting patients.

• Recently UCLH had a backlog of 3 month’s referrals they hadn’t processed. The CCAS safety netting meant that

Camden patients were not affected: – Communication from CCG to practices September 2016: “If you have sent your routine referrals via CCAS then be assured that CCAS already have in place a ‘safety net’ where they escalate un-booked referrals and obtain appointments for the patient outside the DTP process. If you have used the e-RS outside the CCAS process, then you may wish to contact UCLH to check on the status of your referral.”

• With hospitals like UCLH reporting that their highest complaints are around patient accessing appointments CCAS

supporting patients getting their OP appointment is more necessary than ever. – Patient Experience at UCLH – 8 August 2016, page 6: “In outpatients we ask what we can do to improve the

• experience. Around 10% of patients mention cancellations and delays. “.

How CCAS books appointments

Urgent rejections

69 16 12 10 8 6 5 5 5 4 4 4 3 3 3 3 2 1 1 1 1 1 10 20 30 40 50 60 70 80 Ophthalmology GI and Liver (Medicine and Surgery) Ear, Nose and Throat Children's & Adolescents Services Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and Metabolic Medicine Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not Otherwise Specified Infectious Diseases Surgery - Breast Geriatric Medicine

Urgent rejections by specialty 16/17

CCAS helps the patient experience by identifying referrals that have been sent to them as routine but should have been sent as urgent.

New clinical analysis reporting – does CCAS have to review all specialties?

• CCAS assessors review all referrals with the exception of Audiology, which are referred using a proforma.
• In the year 16/17 we have rejected referrals for all the specialties that CCAS receives.

Rejections by Specialty 15/16

The below shows the percentage of GP referrals made that have been rejected by specialty in the year 15/16, CCAS have rejected referrals from all specialties in 15/16:

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Allergy Diagnostic Physiological Measurement Surgery - Not Otherwise Specified Dermatology Ophthalmology GI and Liver (Medicine and Surgery) Respiratory Medicine Surgery - Breast Ear, Nose & Throat Neurology Gynaecology Children's & Adolescent Services Rheumatology Urology Neurosurgery Cardiology Podiatry Sleep Medicine Geriatric Medicine Haematology Endocrinology and Metabolic Medicine Orthopaedics Surgery - Vascular Infectious Diseases Diagnostic Endoscopy Immunology Diabetic Medicine Surgery - Plastic Oral and Maxillofacial Surgery Surgery - Cardiothoracic Pain Management Nephrology Genetics General Medicine Complementary Medicine Genito-Urinary Medicine Rehabilitation Palliative Medicine

Clinical rejections by Specialty 16/17

5 10 15 20 25 30 35 40 45 Ophthalmology GI and Liver (Medicine… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and… Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not… Infectious Diseases Surgery - Breast Geriatric Medicine Diagnostic… Nephrology Allergy Surgery - Plastic Sleep Medicine Diabetic Medicine Oral and Maxillofacial… General Medicine Dietetics Complementary… Immunology Genetics Physiotherapy

Advice and Guidance suggested

• We have looked at rejections by CCAS rejection reason focusing on rejections for clinical reasons.

Rejections by Specialty 16/17

5 10 15 20 25 30 35 40 45 Ophthalmology GI and Liver… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and… Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not… Infectious Diseases Surgery - Breast Geriatric Medicine Diagnostic… Nephrology Allergy Surgery - Plastic Sleep Medicine Diabetic Medicine Oral and Maxillofacial… General Medicine Dietetics Complementary… Immunology Genetics Physiotherapy

Could be managed in Primary Care

5 10 15 20 25 30 35 40 45 Ophthalmology GI and Liver… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and… Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not… Infectious Diseases Surgery - Breast Geriatric Medicine Diagnostic… Nephrology Allergy Surgery - Plastic Sleep Medicine Diabetic Medicine Oral and Maxillofacial… General Medicine Dietetics Complementary… Immunology Genetics Physiotherapy

Could be managed by Intermediate Care

Camden offers intermediate care for:

• Orthopaedics and Pain

Management via the CPAMS and Connect Physical Health services.

• CICS: which offers clinics for

Diabetes, CKD, COPD, Epilepsy, Hypertension and Heart Failure.

• Community Dermatology

Rejections by Specialty 16/17

5 10 15 20 25 30 35 40 45 Ophthalmology GI and Liver… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and… Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not… Infectious Diseases Surgery - Breast Geriatric Medicine Diagnostic… Nephrology Allergy Surgery - Plastic Sleep Medicine Diabetic Medicine Oral and Maxillofacial… General Medicine Dietetics Complementary… Immunology Genetics Physiotherapy

Not in line with agreed local clinical pathways

Many of these Orthopaedics and Pain Management rejections would need to be sent to the MSK or Physiotherapy services

• ffered by Connect Physical

Health.

5 10 15 20 25 30 35 40 45 Ophthalmology GI and Liver… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Rheumatology Haematology Endocrinology and… Surgery - Vascular Neurology Neurosurgery Diagnostic Endoscopy Pain Management Surgery - Not… Infectious Diseases Surgery - Breast Geriatric Medicine Diagnostic… Nephrology Allergy Surgery - Plastic Sleep Medicine Diabetic Medicine Oral and Maxillofacial… General Medicine Dietetics Complementary… Immunology Genetics Physiotherapy

Insufficient clinical information

• We are investigating a system which would provide

– Real time data, rejections by GP etc – Better analysis to see which specialties don’t need to be assessed – More automation so not every referral needs to be assessed. – Cost savings – Better data for CCG

• Currently CCAS has developed a GP data tool, allowing GPs to reflect on there own referral behaviour. A screenshot

is included below:

Investment in new system