Service details, clinic types
The service name is the most important part of defining services effectively on the DOS because, it enables referrers to easily identify the most relevant services, regardless of the provider.
The format for service name which should be used by all service providers is:
Service description-Department name (Optional)-Organisation name-ODS org code
It is important that the service description portion of the service name is as meaningful and specific as possible (within the 100-character limit) so that referrers and patients can select the most appropriate choice of service to create a shortlist.
This allows a short message of up to 100 characters for any important information that a provider particularly wants to bring to a referrer’s attention. As far as possible, these should be unique to the service – overuse of the same alert across a number of services can dilute their impact on referrers.
This must be the site that the patient will attend for their appointment. If services are delivered from more than one site, they must be loaded as a separate service for each location.
Specialty and Clinic Types
All providers should ensure that when defining and loading their services, they use the appropriate specialty and clinic type(s) – the ‘Not Otherwise Specified’ clinic type should be used only where no other clinic type is appropriate. These are the filters most commonly used by referrers to create appropriate shortlists of services for their patients.
The main purpose of a clinic type is to act as a filter to find the right service, rather than to describe exactly what the clinic does. e-RS has its own list of specific clinic types against each specialty – this list is available from the e-RS online help (N3 connection required). If the service is very specific, then the service name should help to make this clear to referrers.
It is possible to map several services to one clinic type and vice versa, thereby enabling all provider organisations to describe their services accurately e.g. the service “soft tissue knee injury” could map to the Clinic types “knee” and “sports injury”. Searching for the clinic type “knee” or “sports injury” would bring up the service “soft tissue knee injury” for that particular organisation.
However, a service can only be mapped to one specialty. If more than one specialty is appropriate the provider will need to consider creating an instance of the service under each specialty.
Request Types Supported
Services may be set up to receive:
- appointment requests: referred patients can book an appointment
- advice requests: referrers can request advice to support the management a patient from a clinician at the provider
- triage requests: referrals can be reviewed by the receiving provider before referring to an appropriate service
Services may simultaneously support appointment or triage requests and advice requests, if appropriate.
Include service on Secondary Care Menu
Including your service on the secondary care menu will ensure that all referring organisations in England are able to find and refer to your service (service restriction details notwithstanding).
If you are setting up a service for use in a local area only, you should select ‘Do Not Include on Secondary Care Menu’. The service will need to be commissioned by a commissioning organisation for it to be visible to referrers in that area. You will need to notify the appropriate commissioning organisations when the service is available for commissioning.
All providers should ensure that when defining and loading their services, they map these to appropriate Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT). This will allow referrers searching for services to produce more consistent and clinically appropriate results.
Standard subsets of SNOMED CT are available for providers to use when defining their service. These subsets are based on the selected specialty and clinic type(s) for the service. Once a clinic type, and associated terms, has been selected, providers have the option, where clinically appropriate, of adding or removing terms from this subset.
Searching via SNOMED CT should be the preferred method of searching for referrers because it is a common language which eventually will be used by all clinical IT systems throughout the NHS. SNOMED CT allows clinical information to be recorded in a structured form – cutting down the potential for differing interpretation of information and the possibility of errors resulting from unclear or ambiguous terms.
Full information on the use of restricted services is available from the using restricted service.
When it is appropriate to restrict a service, this section is used to record the reason for restriction and identify those services, organisations or people authorised to make referrals to the service.
Service priority, patient booking window and indicative wait time calculation
This section is used to identify the priority of referrals accepted by the service and to set a booking window for each clinical priority that the service supports. Waiting times for services that support appointment requests are automatically calculated by the system based on the following:
- for directly bookable services: third available appointment at last slot poll
- for indirectly bookable services: median waiting time for the last 20 bookings
A polling start date and an end date can be set for each priority individually. These dates can be set starting as little as one hour ahead and there does not have to be an end time/date, although if no end date is set only the appointments up to the end of the polling range end date will be displayed.
Any appointments outside of the patient booking window cannot be seen by the referrer, the patient or the appointment line (TAL). However, the provider could still book the patient into any slot (any priroity) even outside the booking window.
More information can be found in the e-RS system Help (N3/HSCN connection required).
This section is used to notify referrers of how to contact the service if they require any further information. If the service is indirectly bookable, it also contains contact booking details.
For clinical and support staff to view and process information relating to the bookings and referrals received by a service, the appropriate workgroups (initially defined within the workgroups tab) will need to be added to the service.
In addition, this section allows services to define which clinicians are available for named clinician referrals and which are also associated with the service.
A NAMED clinician is one who is associated with a service and whose name can be used by a referrer to search for services that have specific, named, slots assigned to them.
An ALLOCATED (but non-named) clinician will still be associated with the service, have an individual worklist assigned (from which to manage referrals), but will not be searchable using the ‘named clinician’ functionality.
Any services where the option “Do Not Include on Secondary Care Menu” was selected in the service details must be commissioned by clinical commissioning groups. Any commissioning arrangements will be shown in this section.
Service Specific Booking Guidance
When a referrer clicks on the service name, information entered in the ‘Service Specific Booking Guidance’, such as the conditions treated, procedures performed and exclusions is displayed on screen.
All providers should ensure that all their services have full and comprehensive service guidance information. This will ensure that referrers short-listing unfamiliar services can review this information and be confident that the service is appropriate for their patient.
Specific information for patients to be aware of should be added to this section. This information will be displayed on screen if the patient books online or in their GP practice, and appears when patients accesses their referrals on the Manage Your Referral (MYR) patient website. If the patient books using the Telephone Appointments Line, information in this section will be read to them.
Service providers should ensure, where the use of ‘dummy’ appointments or restricted services exist, that the process is clearly detailed to avoid any confusion for the patient. For example, patients thinking that they have an appointment in the middle of the night, or on Christmas Day, or seeing that they have been referred (and possibly booked) into a restricted service that they may have been unaware of.
This information should be clearly detailed at the start of the patient instructions, to help ensure that patients do not miss reading it.
In addition, providers should consider how they name their services (refer to the 'Service name' section above) to avoid any confusion to patients, bearing in mind that all services will potentially be visible to patients. For example, patients may not understand terms such as ‘ghost’ or ‘dummy’ appointments, which should be avoided.
For directly bookable services, this section identifies:
- the provider system which contains appointments
- the frequency with which e-RS checks for available appointments
- the number of days in the future for which appointments are checked
- any period of slot reservation (i.e. the number of days during which newly polled slots are only available for booking by the service provider). Further information on the use of slot reservation is available from the e-RS slot reservation page.
This section allows the service provider to identify if a referral letter is required and prevent changes to the referral information within the defined number of days before the appointment - ‘Freeze Time’.
This section identifies whether a service will make use of assessment functionality. Further information on the use of assessment service models is available from the e-RS website under Clinical Assessment Services overview and Managing clinical assessment services pages.
Providers should consider whether their service should be set up using assessment functionality (the patient books an appointment) or using the ‘Triage Request’ request type.
Making services available for referral and booking
Services will be available for referrers and patients to use when the service has been published and has both a valid ‘Service Effect Start Date’ and either a future or blank ‘Service Effective End Date’ (within the ‘Service Details’ section). Additionally, if the service has not been included on the secondary care menu, it must have valid current commissioning rules.