The NHS in England now has a single, searchable resource describing specialist services. The electronic referrals system's directory of services (DoS) lists elective care services that can be via Choose and Book. Appointments can be booked in the GP surgery on the internet or through the Choose and Book appointments line.
There are over 33,000 service entries with descriptions to help GPs to decide which are clinically appropriate for the patient.
Each service provider loads its own DoS entry on to Choose and Book.
When a referring GP searches for appropriate services he or she is presented with a list of different providers with which either the local PCT or, through practice-based commissioning, the practice has a contract in place.
On 30 April 2006 the Extended Choice Network and Choose and Book release 3.0 were introduced, enabling GPs to call up more options if a patient wants to look further afield than their local services.
Extended Choice is a second set of services accessible on the national DoS while release 3.0 is is an upgrade to the Choose and Book software.
Extended Choice services are provided by foundation trusts and nationally commissioned independent sector treatment centres.
The DoS's primary purpose is to ensure patients are referred to the right place, first time. The most important information is the specialties and clinic type lists together with the associated key words or phrases. Making sure services are clearly described in the DoS helps to reduce inappropriate appointments.
Providers should talk to GPs and other referring clinicians about how best to describe their specialist and sub-specialist clinics in the DoS.
For example, if I go to the DoS, click on gynaecology in the specialties list and then on urogynaecology in the clinic type list, this will generate a shortlist of services.
If I (or the patient) want to find out more about a specific service, the service details page will state what kinds of conditions are treated in the clinic, the types of investigations and procedures carried out and the clinical problems that the service does not deal with.
Using Choose and Book release 3.0, GPs can now search by organisation name, abbreviation or nickname such as 'Guy's' or 'Jimmy's'. Or you can search by 'indicative wait time' if the patient wants to be seen quickly.
With the focus on moving care out into community settings, the DoS will increasingly host services provided in non-hospital settings.
Since May 2005 it has been possible to use the DoS to refer patients to a GPSI (if available) for specialist care. The practice where the GPSI is based thus becomes the service provider and must ensure that the service is accurately described on the DoS.
Providers can add extra information specific to each of their services to DoS entries - for example, pointing out that a procedure cannot be carried out if the patient has eaten anything during the six hours before their appointment.
If this type of advice is in the DoS for a particular service, it will be given to the patient by the referring GP or by the appointments line when a booking is made.
Patients can also find links to supplementary information about each service in the DoS by searching on the NHS website under Choose and Book.
However, one of the key challenges for Choose and Book is the standardising of the terms and key words used to described specialist services in terms of their specialty and clinic type.
For example, if I have a patient with dyslipidaemia I may click on general medicine as the specialty, but the appropriate clinic type may be metabolic medicine or lipid disorders, depending on the trust.
In the longer term, clinical coding will be used to overcome this.
It is crucial for service providers to work with their referring GPs to improve the DoS. GP commissioners need to ensure that providers have a DoS improvement plan that includes active primary and secondary care involvement. Ideally it will include an easy way for referring clinicians to give immediate feedback when they come across a problem with their local DoS.
Improving the service
I advise all GPs using Choose and Book to give feedback so that entries that are unclear can be amended in a consistent way. This is an area where primary and secondary care should work closely together.
When referring individual patients, if I have any doubt about whether a service is appropriate, I have the option of using the Choose and Book advice and guidance function. This enables me to ask secondary care colleagues about whether a patient needs to be referred before actually making the decision.
There is also lots of information about the DoS on the Choose and Book website including advice on how to identify services correctly. GPs who are novice Choose and Book users may find this particularly useful.
GPs can help to develop and refine the DoS by taking part in local providers' reviews of their DoS entries. When discussing improvements and changes, I suggest using any service from which you get an unusually high rate of rejected referrals as a starting point.
The DoS is the cornerstone of ensuring we can facilitate choice and refer our patients to the right clinics. But despite a good start, there are still some challenges.
The best way to address these is for clinicians to work together. Ensuring the DoS works correctly will benefit GPs and, more importantly, our patients.
- Dr Davies is a North Yorkshire GP and national medical director (primary care) at NHS Connecting for Health
DIRECTORY OF SERVICES QUICK READ
- The DoS is the national database of elective care services listed in the Choose and Book system.
- Its primary purpose is to ensure patients are referred to the right place, first time.
- You can search for services by selecting specialties and clinic types, by using keyword searches, by indicative wait time or by specific organisation name or abbreviation (e.g., Jimmy's or Guy's).
- All providers, including those based in primary care, should ensure their services are accurately displayed.
- Searches can be 'challenging' because service providers deliver services and organise their DoS entries differently.
- Work is under way to ensure national standards for clinical terms and keywords used in the DoS to make finding services easier.
DoS Choose and Book national elective care Directory of Services.
Extended Choice Supplementary DoS list of foundation trusts' and independent sector treatment centres' services.
Choose and Book release 3.0 Latest upgrade to Choose and Book software (released 30 April 2006).
- www.chooseandbook.nhs.uk/staff/dos for more about the directory of services.
- Local PCT Choose and Book lead for local information.