• How CCAS benefits patient access and experience • New clinical analysis reporting
How CCAS benefits patient access and experience
What Does CCAS Do? • 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 1 st 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.
How CCAS books appointments • 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. “.
as urgent. CCAS helps the patient experience by identifying referrals that have been sent to them as routine but should have been sent Urgent rejections 10 20 30 40 50 60 70 80 0 Ophthalmology 69 16 GI and Liver (Medicine and Surgery) 12 Ear, Nose and Throat 10 Children's & Adolescents Services Dermatology 8 Urgent rejections by specialty 16/17 Cardiology 6 Orthopaedics 5 Urology 5 Respiratory Medicine 5 Gynaecology 4 Rheumatology 4 Haematology 4 Endocrinology and Metabolic Medicine 3 Surgery - Vascular 3 Neurology 3 Neurosurgery 3 Diagnostic Endoscopy 2 Pain Management 1 Surgery - Not Otherwise Specified 1 Infectious Diseases 1 Surgery - Breast 1 Geriatric Medicine 1
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 rejected referrals from all specialties in 15/16: The below shows the percentage of GP referrals made that have been rejected by specialty in the year 15/16, CCAS have 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% 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
10 15 20 25 30 35 40 45 • We have looked at rejections by CCAS rejection reason focusing on rejections for clinical reasons. 0 5 Clinical rejections by Specialty 16/17 Ophthalmology GI and Liver (Medicine… Ear, Nose and Throat Children's &… Dermatology Cardiology Orthopaedics Urology Respiratory Medicine Gynaecology Advice and Guidance suggested 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
10 15 20 25 30 35 40 45 10 15 20 25 30 35 40 45 0 5 0 5 Rejections by Specialty 16/17 Ophthalmology Ophthalmology GI and Liver… GI and Liver… Ear, Nose and Throat Ear, Nose and Throat Children's &… Children's &… Dermatology Dermatology Cardiology Cardiology Orthopaedics Orthopaedics Urology Urology Could be managed by Intermediate Care Respiratory Medicine Respiratory Medicine Could be managed in Primary Care Gynaecology Gynaecology Rheumatology Rheumatology Haematology Haematology Endocrinology and… Endocrinology and… Surgery - Vascular Surgery - Vascular Neurology Neurology Neurosurgery Neurosurgery Diagnostic Endoscopy Diagnostic Endoscopy Pain Management Pain Management Surgery - Not… Surgery - Not… Infectious Diseases Infectious Diseases Surgery - Breast Surgery - Breast Geriatric Medicine Geriatric Medicine Diagnostic… Diagnostic… Nephrology Nephrology Allergy Allergy Surgery - Plastic Surgery - Plastic Sleep Medicine Sleep Medicine Diabetic Medicine Diabetic Medicine Oral and Maxillofacial… Oral and Maxillofacial… General Medicine General Medicine Dietetics Dietetics Complementary… Complementary… Immunology Immunology Genetics Genetics Physiotherapy Physiotherapy • Community Dermatology • CICS: which offers clinics for • Orthopaedics and Pain care for: Camden offers intermediate Heart Failure. Epilepsy, Hypertension and Diabetes, CKD, COPD, services. and Connect Physical Health Management via the CPAMS
10 15 20 25 30 35 40 45 10 15 20 25 30 35 40 45 0 5 0 5 Rejections by Specialty 16/17 Ophthalmology Ophthalmology GI and Liver… GI and Liver… Ear, Nose and Throat Ear, Nose and Throat Children's &… Children's &… Dermatology Dermatology Cardiology Cardiology Not in line with agreed local clinical pathways Orthopaedics Orthopaedics Urology Urology Respiratory Medicine Respiratory Medicine Gynaecology Gynaecology Insufficient clinical information Rheumatology Rheumatology Haematology Haematology Endocrinology and… Endocrinology and… Surgery - Vascular Surgery - Vascular Neurology Neurology Neurosurgery Neurosurgery Diagnostic Endoscopy Diagnostic Endoscopy Pain Management Pain Management Surgery - Not… Surgery - Not… Infectious Diseases Infectious Diseases Surgery - Breast Surgery - Breast Geriatric Medicine Geriatric Medicine Diagnostic… Diagnostic… Nephrology Nephrology Allergy Allergy Surgery - Plastic Surgery - Plastic Sleep Medicine Sleep Medicine Diabetic Medicine Diabetic Medicine Oral and Maxillofacial… Oral and Maxillofacial… General Medicine General Medicine Dietetics Dietetics Complementary… Complementary… Immunology Immunology Genetics Genetics Physiotherapy Physiotherapy Health. offered by Connect Physical MSK or Physiotherapy services would need to be sent to the Pain Management rejections Many of these Orthopaedics and
Investment in new system • 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:
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