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Paperless NHS means paperless referrals

18 December 2012   Lis Evenstad

Tim Kelsey

The NHS Commissioning Board’s planning guidance, issued today, has confirmed that a “paperless NHS” means paperless referrals by 2015.

In October, the NHS Commissioning Board’s national director of patients and information, Tim Kelsey, told the Healthcare Efficiency Through Technology Expo that the government’s mandate to the NHS CB would include a commitment to a paperless NHS by 2015.

He said he wanted to “eradicate paper from the NHS” and that there would be no more “referral letters or lost records because we won’t have paper anymore in the health service.”

His statement created a lot of enthusiasm and debate, with many questioning how realistic Kelsey’s goal was.

However, at the Digital by Default conference this month, Kelsey explained that his reference to a “paperless NHS by 2015” meant paperless referrals; and not an entirely paperless health service.

Today’s planning guidance confirms this. It says: “We shall support a move to paperless referrals in the NHS by March 2015 so that patients and carers can easily book appointments in primary and secondary care.”

This will be achieved through the re-launch of the Choose and Book electronic booking service, which the Department of Health is in the process of re-procuring, even though use peaked at about 50% of referrals and has been falling.

Today’s guidance – ‘Everyone counts: planning for patients 2013-14’ – contains a number of commitments intended to provide more information for commissioners and patients, predicated on the use of more modern IT systems.

The document revisits the government’s pledge to give patients electronic access to their records, and apparently extends it.

It not only says there will be a “guarantee” that every patient will have online access to their primary care medical record by spring 2015, but that there will be a consultation on how to open up other records.

“We will consult, by June 2013, on plans for the provision of patient access to interoperable records across the pathway of care.”

When it comes to new information sources for patients, the guidance’s most striking commitment is to publish outcome data for most patients in England, which is now being widely debated.

The guidance also says that all NHS funded patients “will have the opportunity to leave feedback on any service by 2015.”

And it says that the new ‘friends and family’ test will be introduced for A&E and maternity services in April and October next year respectively.

This is despite concerns that the test – which asks patients on a six point scale whether they would recommend the place they were treated to loved ones – will be well understood and provide valid, comparable data.

This is the CB’s first planning guidance, and replaces the Operating Framework for the NHS in England that was published by the Department of Health each December.

NHS North and the North West Health Informatics Leadership Network recently held a conference on the benefits of opening up access to records for patients. Read Jon Hoeksma's report of the event in Insight.


Related Articles:

3 News: NHS CB promises new quality data | 18 December 2012
4 Insight: EHI interview: Tim Kelsey | 3 October 2012
2 News: Cautious support for data publication | 18 December 2012
18 News: New GP data set to assess quality | 7 December 2012
31 News: NHS to be 'paperless' by 2015 - Kelsey | 10 October 2012
Last updated: 20 December 2012 07:05

© 2012 EHealth Media.


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Lets drop the semantics

in arduis fidelis 103 weeks ago

...and the personal vested interests. The capability and technology to make this acheivable has been around for sometime now. All it takes is for people to shut up and put up. I've proved it can be done, without endless meetings and prevarication, just getting on, getting it done and providing the proper support for all involved. Removing paper from the transfer of first appointment referrals between GPs and secondary/community care etc by 2015 is not the problem. Requests for follow ups, consultant to consultant/internal referrals, referral from acute to community now theres a problem to get your teeth in to, there are possible workarounds NHS mail, EDI links etc but no definitive solution, even C&B V2 could have the potential to handle this.

So lets stop finding excuses and drive this thing, lets all get our hands dirty in 2013, we all know the benefits of this to patients to their continuity/quality of care and safety.


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Jacques' haemorrhoids are eternally grateful

JacquesOuze 104 weeks ago

I thought it meant a switch over to Izal medicated across the entire NHS, what with transparency being the mot du jour. I'm mightily relieved this is not the case.

Is that too much information?

Ah well - Bon Noel et joyeuse fetes - thanks to Jon and the team for an excellent year of reporting!


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Open standards is the only way forward

Neelam Dugar 104 weeks ago

I applaud the vision. It is the correct vision for NHS.

For this vision to be realised use of open global standards it key.

1. Medical documents must be exchanged in basic CDA format--pdf with minimal xml metadata wrapper

2. Document exchange standard should be XDR of IHE

I would suggest that the commissioning board work with HL-7 UK & IHE UK so that we adopt global standards which are simple for our suppliers in both primary & secondary care.

Vendor lock-in my proprietary non-global standards will be a huge mistake for NHS


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At this time last year

in arduis fidelis 104 weeks ago

Thought I'd post a quote an article from a year ago

"NHS Outer North East London primary care IT project manager Simon Wheat said Barking and Dagenham practices were making more than 3000 referrals to acute, community and other services every month through Choose and Book.

Barking, Havering and Redbridge University Hospitals NHS Trust had worked with the PCT to go paperless for first outpatient appointments in December last year by making 99% of hospital departments available, he said. Any paper referrals were triaged and sent back to the practice unless the patient was at risk or there was a technical problem" - EHI article 23 December 2011

By the time that article was published that process had already been running for over 12 months, with no reported clinical incident.

And 1 year on from that article, two years on from the initial migration, (to use the benchmark quoted above), last weeks C&B %OP utilisation for B&D was 100%, still paperless to all OP services at BHRUHT that are on C&B (99% of OP services)

Guess the size of the C&B support team that was used to bring that change about for a PCT of 42 GP practices


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Oh Humpty

Ewan Davis 104 weeks ago

I cant help thinking that "a paperless NHS" does NOT MEAN "Paperless Referrals" unless you take serious liberties with the grammar and semantics of the English language. Just as I struggle to understand how "online patient record access" apparently does not actually require online access to your record.

To help understand what's going on I have to turn to Humpty Dumpty who said.

"When I use a word, Humpty Dumpty said, in rather a scornful tone, it means just what I choose it to mean%u214neither more nor less."

Or maybe my daughter's erudite thesis:

ionadavis.files.wordpress.com/2012/09/dissertation-july-endnotes.pdf

Merry Christmas


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Agreed

KeepItSimple 104 weeks ago

I agree wholeheartedly with your first paragraph. Can't they 'transparently' admit that the Director, new in post and keen to impress, misspoke?


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Open Standards are key to this

Tom Whicher 104 weeks ago

The only way to make this work is to have CAB V2 designed with interoperability and data transfer as first principles. Technically it shouldn't be difficult but the national referral system needs that base to make it a viable.

Getting this right there can give significant gains in clinic productivity and reduced administration at both acute and primary sites, as well as the patient care benefits.


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Hmmmm

in arduis fidelis 104 weeks ago

Whilst I eagerly await CAB V2 and the extra functionality it promises, the current version has interoperability, the problem is the enthusiasm and eagerness of system suppliers to actually integrate further, it is after all a two way street. For example SNOMED clinical terms were not just introduced to C&B to allow a more clinical approach to searching for services, the idea was that it would give a base for GP system suppliers to work on coding across the whole service search process from the consultation jumping straight to the service selection screen. 7 years on from the first GP clinical system/C&B integration (EMIS LV) they still only populate the patient search phase, who's to blame there. I spoke to one GDP clinical system provider about integration and they said it wasn't on their road map until there was a definite need in the dental community, (another didn't even respond to my question). There is data transfer capability too, GP clinical systems can attach documents to a C&B referral without the need to navigate to the C&b web site

Getting the facts, usage and potential of the current C&B system right can also give significant gains in clinic productivity and reduced administration at Acute, Community and Primary sites.


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No NHS treatment if "vulnerable" on PDS?

Mary Hawking 104 weeks ago

There are a small number of patients who have declared themselves to be "vulnerable" on PDS, which means that their demographics are not displayed - no address, phone number or registered GP.

These patients cannot be handled on services using PDS - C&B, EPS and GP2GP.

Does this plan mean that some way round lack of demoraphics for these patients (think animal rights and abusive ex-partners) has been found, or will they be unable to be referred under the NHS?

And what about referrals from situations without access to C&B?


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Punishing the Vunerable

Ewan Davis 104 weeks ago

My view is that using the PDS in this way was done deliberately to discourage people from asking to be flagged as vulnerable by linking this unnecessarily to a denial of access to services.

I understand that PDS has a mechanism such that stop-noted records can be found if you already have matching demographic data. This makes it impossible to gain access to information you don't already know but allows you to identify the stop-noted record on PDS providing a mechanism to deliver services such as EPS GP2GP and C&B to stop-noted patients.

All they have to do is turn it on.


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there are some business continuity possibilities

in arduis fidelis 104 weeks ago

Whilst not all inclusive there are some potential business continuity solutions that could be used in some of these instances:

eReferrals using secure email such as NHS mail for example. In fact Providers can implement eFax systems now (I've just done a business case for introducing such a system) which means that they can potentially move to paperless referrals now for all patients from all organisations using a combination of C&B, NHS mail and eFax. From a GP/Practice/all patient perspective moving from paper referrals to a combination of eFax, NHS mail and C&B not only would be a substantial financial saver, the reduction in Clinical incidents associated with lost letters, misread letters etc can be reduced (using these methods keeps everything in electronic form at both ends which means no handwritten referrals - assuming mail merged templates have been set up in your system).

Whilst a "paperlight" substitute for GP2GP for the patients you describe could be introduced with the introduction of a recordable media policy and installing a CD/DVD burner in each practice.

EPS no obvious current tech solution springs to mind (I'm sure someone out there has one), however there are online Pharmacies that allow for scripts by email to be set up but don't require the patient to be accessible on PDS.

These obviously are local workarounds.

As to national solutions, not too sure and admittedly they have been conspicuous by their absence particularly for C&B, EPS and GP2GP that have been around for a number of years now


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to answer the other question about emails

in arduis fidelis 104 weeks ago

my response is similar to the C&B one . So things would have to change at the hospital end , unfortunately a great many consultants still expect the referrals to be on paper, so in a lot of cases any electronic referral is printed out by a contact/booking team sent internal mail to the consultant/secretary, the obvious flaw in this process is that sometimes the letter doesn't make it back down to clinic prep in time for the appointment. Which can lead to last minute requests for leters to be faxed over by practices, even for a C&B referral if it hasn't been uploaded to a PAS/EPR or the prep team hasn't been shown hw to find it again on C&B


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Mary

in arduis fidelis 104 weeks ago

with C&B the only legitimate reason why (assuming everything has been attached by the referring practice) the referral letter and attachments wouldn't be available for the first consult at a provider is if the consultant does not have access to an N3 connected PC and don't let anyone tell you any different. just like the only truly legitimate reason for a provider to ask you to Fax over the referral letter is if its because of an Appointment slot issue and they have to book it outside of C&B. Almost all problems xperienced with C&B referrals are usually associated with bad practice/processes rather than the tool itself. Anything else you would like to know happy to help


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That's a thought..

Mary Hawking 104 weeks ago

if referrals which, for any reason, could not be sent via C&B, were sent via NHS Mail (i.e. also electronically), would we stop hearing from patients and consultants that the consultant didn't have the referral letter when the patient was seen?

Or would this require something to happen at the hospital end?

btw, does anyone know whether patients referred via C&B always have the referral available when they are seen?


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even though use peaked at about 50% o referrals and has been falling

in arduis fidelis 104 weeks ago

Just to clarify something here, the % "Outpatient" utilisation figure you quote is purely advisory as it is calculated using a historical "referral figure" denominator and it only takes in to account those services that are set up on the DoS as "Outpatient Services". Perhaps you should request the "total bookings" figures trend (upwards) for your reports for accuracy purposes, as this includes all C&B published services - Outpatients, Community, Assessment, GPWSI, Nurse led, AHP, Mental Health.

I emphasise this as most PCTs/CCGs have been managing more patients closer to home which means a shift in the demographic from secondary care (ie "OutPatient " services), additionally most RAS, RMS and CAS (which are on the increase) are usually set up as "Assessment Services" on the DoS to allow for the "refer-on" and "assessment Report" functions to be active.

In fact a number of us cite the % Outpatient Utilisation figure as counter-productive where GPs/Practices are using C&B routinely for local/community services, but are hounded by misinformed executives/media commentry for under performance based on this %.

Plus at this time of year, as with most areas of Healthcare, there is a seasonal downturn.

C&B/paperless referrals - it can be done (without incentive payments) with the help of informed debate, discussion and commentary, not myth, propaganda and diatribe

Want to know more

uk.linkedin.com/pub/simon-wheat/15/28a/b1


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Supporting information

in arduis fidelis 104 weeks ago

A working example for factual purposes:

A London PCT in Sept showed 24% OP Utilisation for C&B and in November showed 28% OP Utilisation an increase of 4%.

However taking in to account the C&B go-live of their community MSK (set up as an Assessment/AHP service) in September, Total C&B bookings for Sept (inc OP) were 1497 and in November they were 2081 which unless my maths fails me is a 39% increase in all bookings made through C&B


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