The Scottish Government

1. Portfolio/Number/Name:H/T 5 Outpatient Programme: Patient Focussed Booking

2. Programme/Activity:

Patient focussed booking is being introduced for appropriate new patients across Scotland and for return patients also in some areas. Patient focussed booking allows patients to have some input into the day and time of their appointment. Before this project was initiated the vast majority of patient appointments were offered fixed appointments where no choice was given. It also assists in managing the waiting list by ensuring that all routine patients are seen in chronological order. This was difficult previously as often clinics would be cancelled and re-booked or patients were moved forward in the queue.

3. Efficiency

3.1 Current target; £m

2005-06

2006-07

2007-08

Cash

0

0

0

Time

2.59

2.59

2.59

3.2 Efficiencies delivered; £m

2005-06

2006-07

2007-08

Cash

0

-

-

Time

1.12

-

-

4. Accountable Officer for delivery

Kevin Woods

5. Project Manager

Stephen Gallagher

6. EGDD Portfolio Manager

Rowena Simpson

7. Description of efficiency and actions to be taken

7.1 What is the efficiency improvement? How will the efficiencies be made?

With patient focussed booking, there is greater likelihood of the patient making their appointment and a greater likelihood of clinics running as planned. This will result in:

• Decreased patient cancellation rates which result in non attendance ( DNA) rates to 5% or less in the 30 plus participating sites;
• Booking patients chronologically increases queuing efficiency and reduces initiatives to manage the longest waiters. We know that patients have not been booked in strict chronological order in the past due to different vetting timescales, patient pressure and the ability of clinicians to pull certain patients forward. Hospital driven cancellations also leads to "churn" of the lists;
• Decreased hospital cancellation rates.

7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement?

The efficiency improvement requires:

• Delivery of appropriate computer software packages (particularly for return appointments);
• Robust policies on clinic cancellation, consultants leave, DNAs.
• Changes in working practice within medical records

8. Associated costs

8.1 Are there any development or redundancy costs associated with the delivery of this efficiency?

This project was embarked upon to secure better patient access and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.

9. Measurement

9.1 What are the inputs that will be measured?

This project is not established on measuring cost savings but data collection is in place, which will allow for extrapolation and further analysis.

The inputs being measured are the number of clinics taking up the new Patient Focussed Booking approach during the lifetime of the CCI Outpatients Programme.

9.2 What are the outputs that will be measured?

The outputs that will be measured are the spread of PFB implementation for the duration of the outpatients programme (to March 2006), hospital cancellation rates and 'did not attend' rates. Patient satisfaction has also been determined through a survey of patients in Dermatology clinics throughout Scotland in 2005.

Sites are measuring DNA rates, cancellation rates and waiting times.

Audit Scotland calculate DNA rate of 1 in 7 (14%)

DNAs cost £20m per annum (Audit Scotland 2003)

PFB should reduce DNA rates to 5% or less

Audit Scotland calculate that there is a total of 10 million OP attendances.

Acute Hospitals see 6.5 million patients;

31% of appointments are first appointments

All Acute Hospitals are implementing PFB for first appointments

(6.5/10 of £20m)

(£13m x 31%)

(9/14 improvement of £4.03m)

This gives a time releasing saving of £2.59m on Did Not Attends.

National definitions and metrics do not yet exist for hospital cancellations and so no value is yet attributed to these expected improvements. However, Audit Scotland estimated that 1% of clinics are cancelled which may be as many as 100,000 appointments of which 65,000 would be in hospitals.

Where possible, PFB utilises existing data reporting systems e.g. MMI data, which is reported to the National Waiting Times Unit. Due to the requirement for timely reporting, this data is not fully validated.

In addition to the above, due to the poor nature of some of the outpatients data currently collected and the fact that data on patients seen by anyone other than a consultant not yet collected there are some risks to collection and accuracy.

Quantitative data is collected monthly, where possible, using existing data reporting processes e.g. MMI (monthly management information) data. Qualitative data (in the form of staff and patient satisfaction surveys) is collected locally and fed into Centre for Change and Innovation ( CCI).

9.3 What is the baseline for inputs and outputs?

No patients were booked through Patient Focussed Booking prior to the project launch in November 2003. Switching to the new approach began incrementally during 2004/5 and data for 2005/2006 represents the build up of implementation that is continuing.

10. Quality cross-check

10.1 What quality indicators are being used to ensure that quality of service is maintained or improved?

Improved quality for patients through:

• choice over date and time of appointment;
• continued validation of the need for an appointment;
• less time spent waiting in clinics;
• reduced DNA rates (target of 5% or less by December 2005).

A sample survey of patients attending dermatology clinics in 2005 highlighted

• 98% of patients felt happy to telephone to arrange an appointment
• 89% of patients felt that they were given choice over their appointment
• 97% of patients were happy with the appointment they received
• 10% of patients had difficulty getting through to appointment centres.

11. Monitoring

11.1 What are the arrangements for monitoring the delivery of efficiencies?

Monthly monitoring and reporting of:

• DNA rates;
• Clinic cancellation rates;
• Outpatients waiting over 26 weeks;
• Longest outpatient waiting time by specialty;
• Implementation of PFB across specialties.

12. Reporting

12.1 What are the arrangements for reporting the delivery of efficiencies?

PFB Project Managers at each site are responsible for reporting to the National PFB Project Manager.

13. Dependencies

13.1 Explain if your efficiencies are dependent on legislation or other structural changes being achieved.

There are no legislative dependencies

More dedicated outpatient and queue management.

14. Use of efficiencies

14.1 How are the efficiencies released from improvement activity being used to improve front-line services?

Funding allocations from SEHD to NHS Boards for outpatient services did not assume an increase in the number of patient contacts. Due to the nature of the project there is no time released, but time is more productively applied, resulting in increased throughput.