Where board-level management take a proactive part in the implementation of e-RS and particularly direct booking, it is more likely that the necessary support will be made available to enable the project to succeed.
e-RS is a clinical programme, requiring clinician support and co-operation in both primary and secondary care. Clinical input is required for all aspects of the system, but particularly in the following areas:
Design of the directory of services (DoS)
A good DoS is the key to successful implementation, and input from both consultants and referrers is crucial to this success. Consultants need to ensure that the DoS accurately describes the services and clinic types available, and referrers need to help ensure that the descriptions and associated clinical terms enable them to find the appropriate choices for the patient. It is also crucial to ensure that consultants understand exactly what the GPs see on the screen when searching for services, as this will facilitate good design. Find out more about directory of services.
A prerequisite to a successful implementation of direct booking is to have good control over waiting lists and waiting times, and to ensure that the capacity available in clinic is used to maximum effect. Failure to review the business processes attached to clinics could result in waiting time breaches and/or lack of available slots for patients to book into.
Providers often have concerns around the publication of all slots to e-RS, which may be seen as ‘losing control’ of the waiting list and the management of waiting time targets. These concerns can be overcome if both commissioners and providers work together to understand the demands on services, and NHS contracts provide for the correct levels of activity.
Organisations need to bear in mind that patients have a choice of provider and are entitled to receive an appointment with their chosen hospital. Provider capacity should not be a barrier; any financial issues that may affect the management of activity levels locally need to be addressed through the contracting process and should not be attributed to the e-RS system.
One of the main barriers to successful implementation of direct booking is the availability of appointment slots. Difficulty often arises because the provider is failing to meet demand or is not allocating enough of the available resources to direct booking. This difficulty may be compounded while running both old manual pathways and new electronic pathways in the transition. But it may be that commissioners are seeking to manage demand by placing constraints on the treatment of patients who have been referred. It is not appropriate for either commissioners or providers to limit referral of patients by restricting the availability of slots or the refusal of referrals other than on clinical grounds. This is reflected in the operating framework and NHS contract.
e-RS will very quickly highlight a genuine imbalance between available capacity and demand, and patients will find that there are no slots available at their chosen provider.