A Proposal for Dacorum or West Herts Alternative for CAS and CATS

Patient Activity Reporting Service ©

A new reason to develop data gathering has arisen in the last few months – the requirement to introduce referral management, usually in the form of Clinical Assessment Services or Clinical Assessment and Treatment Services (CAS and CATS), whereby all referrals are logged and vetted. This would be another tier, away from practices, which would collate referral letters.

The vision is to unite the need for accurate and timely data for Practice Based Commissioning and the desire for PCTs and some PBC groups to have some form of referral management within one data collection system.

Referral activity is recorded by a new Patient Activity Reporting Service, either instead of a CAS or CATS relying on later changes in pathways, or as part of current CAS and CATS. The PARS would produce monthly reports of referral activity, costs, and also show the patterns of care which could be changed either by training needs or by new pathways or by practice based providing.

Currently in Hertfordshire we only have crude and out of date data (Himas) which does not give the reasons for referrals or details of the hospital response. It is not clear what could be efficiently, safely and practically provided in primary care without live data.

The data produced by the Patient Activity Reporting Service would show actual expenditure for each month and committed expenditure. It would give waiting list details and also information about DNAs. For medico-legal reasons GPs should be aware of delays in treatment, and getting such reports again would be a clinically useful service alone (akin to PACT data for referrals).

Information for Practice Based Commissioning needs to be timely. HIDAS and the data from NWCS/SUS are 6 months out of date by the time we see them.
The PCTs are keen, if not determined, to develop CAS and CATS services.
We need to run PBC with accurate data. The commissioning side needs to know planned activity and actual activity within a day of month end.
PBC data will allow Commissioning groups discover patterns and redirect services. It adds meat to the PBC process, and has been missing to date.
The data collected would not only provide referral information and financial information based on actual practice data, which is based on incoming and outgoing referral letters. We could then reinstate the stipulation that no payment is made by the PCT if no clinical letter was received.
It would also allow for educational needs to be developed. It can be an automatic PUNs/DENs generator. It could allow us to re-establish local educational meetings.
The Data Service could then develop arrangements with PBC to develop protocols, or reciprocal contracts, which would enable practices to be paid for extra work they do. The Service administers these arrangements. Provision is provided by practices or NHS Trusts.

Progress in April 2007

Server software has been modified to use HRG codes, and to produce monthly reports with the rigor of Fundholding Software. It gives referral reports but also a financial report based on our indicative PBC budgets. It would be PBC group wide, but can be extended. The server is now up and running and being beta tested. The software is held on a server within NHS net: http://172.22.203.242 and could be accessed by practices for reading reports or data input. Instructions and the SSH login programme required can be downloaded from that address, which can only be accessed from within the NHS net.

Staff in larger practices could be trained to put the data on, or data clerks could visit practices to input the data. Certainly practices would have access to their data on line, even if they did not input the data in-house.

An easier approach is to centralise data input. Copies of outgoing referral letters and incoming patient letters would be emailed using nhs.net email. It must be nhs.net email as it is encrypted (there are other systems that can encrypt email to send and receive but they require extra clicks…easily forgotten).

Clearly there are Caldicott issues in this approach. Copies are to go to a clinical (doctor-led) service within the NHS net, and the service part of PBC. It is directly related to patient care.

The HIDAS (Midas) reporting system that is currently available to all GP practices in West Herts on NHS net site: http://10.150.193.31/home/ allows you to drill down to individual patients. The trouble with that site is that consists of out of date data based on hospital data input. There is no data validation. Primary care data is likely to be accurate, as we know our patients and have all the letters. The proposed service would fall well within the latest guidelines at DH on http://tinyurl.com/26rkba

To save data input we would require a download of patient lists from clinical systems or from the PCT/PSU Exeter system. Other data has already been collected and is ready to be imported onto the system – such as consultant codes, GP and practice codes, and Provider details and codes.

Patient Data: this requires the correct protocols in place regarding patient confidentiality as apply to General Practice. We have the Miquest HQL editor that would allow us to create a Miquest search, in order to collect the data in the correct format to input onto the Patient Activity Server. Pat Potts of Herts PCTs has kindly generated a search which has been tested and could allow lists of patients to be extracted and imported.

We have developed a system for rapid secure data extraction.

At first data input will be centralised, but current practices could do it within their surgeries by logging into our server (and be paid accordingly).

We have collected together the codes and HRG prices for importation. Different prices to different providers, including primary care provision, can be added later. Prices can vary as HRGs can be “unbundled” and some services are outside tariff.

Below are example of the names of files of scanned in documents that would be fowarded for process.

© Gerry Bulger

0783 122 3669

Gerard.bulger@archway.nhs.uk

Example of the file names of the table of scanned in documents

Anticoagulant Clinic{C-West Herts Trust Letter

Cardiology urgent referral{C-West Herts Trust Letter

Chest pain clinic urgent referral{C-West Herts Trust Letter

Chest pain clinic{C-West Herts Trust Letter

Chest X%2dray{C-West Herts Trust Letter

cardio referral{I-SK

DVT Clinic{C-West Herts Trust Letter

Early intervention team{C-West Herts Trust Letter

Ecg{C-Archway Surgery Data

Ophthalmology{C-Other NHS Hospitals

Diabetic annual review{C-West Herts Trust Letter

diabetic{C-West Herts Trust Letter

retinal screening{C-West Herts Trust Letter

Urgent 2 Wk Referral{C-Outgoing Letter

Histopathology{C-West Herts Trust Letter

A&E{C-West Herts Trust Letter

Casualty Consultant{C-Outgoing Letter

Coloproctologist{C-West Herts Trust Letter

Coloproctology{C-West Herts Trust Letter

deceased in%2dpt summary{C-West Herts Trust Letter

ss referral{I-SK

{C-Photo

Discharge Drugs{C-Other NHS Hospitals

Discharge summary{C-West Herts Trust Letter

drugs and info{C-West Herts Trust Letter

Harmoni{C-Non Hospital

letter to a&e{I-SK

Oncology{C-West Herts Trust Letter

Patient Summary{C-Other NHS Hospitals

Transfer Summary{C-West Herts Trust Letter

x%2dray result{C-West Herts Trust Letter

day hospital{C-West Herts Trust Letter

Discharge Summary{C-West Herts Trust Letter

Drug Treatment{C-West Herts Trust Letter

urology nurse referral{I-SK

Cardioloy{Private Hospitals{I-SK

Urology{C-West Herts Trust Letter

2 wk urgent referral{C-Outgoing Letter

leg{C-Photo

Flexible Cystoscopy Report{C-West Herts Trust Letter