primary care

Published: 16/01/2003, Volume II3, No. 5838 Page 30 31

Until now, the national booking programme has been largely focused on hospitals.But a call centre set up in a primary care trust is now handling community bookings. John Pattinson reports

South Leeds primary care trust has developed a contact centre as part of its work to modernise booking services. The NHS plan states that by 2005 patients will be able to book their hospital appointments at a date and time convenient to them. Until recently, much of the work within the national booking programme has focused on acute trusts. But the fourth wave, moving to mainstream, has considered whole health communities - groups of trusts working together to introduce booking systems. South Leeds PCT is pioneering booking work within the primary care sector.

The original idea was for a central contact centre, which would make bookings for a variety of community services developed by the PCT. Once a suitable location had been identified - in a health centre - work began on turning these ideas into reality.

Estimates from known service activity were translated into likely numbers of staffing, along with the supporting infrastructure of office furniture, telephones, fax, computers and storage.

Approximately 3,000 bookings are expected by the end of the first year.

The centre, which went live in April 2002, is staffed by a supervisor and four part-time call operators. It was established with a£14,000 grant from the Modernisation Agency and running costs are expected to be£100,000 a year. The centre operates from 8.30am-7.30pm, Monday and Tuesday, and 8.30am-4.30pm on Wednesday, Thursday and Friday. It is hoped to extend the service to 7.30pm every evening.

The first three services to be booked via the service are community physiotherapy, ophthalmology (retinal screening) and minor surgery. A partial booking system had been established for ophthalmology before the centre was set up.When a GP makes a referral to one of these services, the relevant service contacts the call centre, which then rings the patient to agree an appointment. The call operatives work to a set script and advise on clothing, in the case of physiotherapy appointments, and, in the case of retinal screening, not driving to the appointment.

If the centre is unable to talk to the patient within one working day of the decision to treat (the target set in the national booking programme), the centre sends a letter to the patient asking them to ring a freephone number to fix an appointment. Though we have yet to analyse the time patients take to respond to a letter, we believe it is a couple of days in most cases.

We have found, from patient satisfaction questionnaires sent out in August, that 95 per cent of patients were happy to make their booking over the telephone and all patients found the contact centre staff helpful.

Booking has had a positive impact on the physiotherapy service.Waiting time was as long as 16 weeks when the centre went into operation.

During the first three months of booking, the waiting time was reduced to four weeks. The process of booking has helped to validate the waiting list and reduce non-attendance rates from 18 to 2.5 per cent and provides a flexible system which can fill appointment slots at short notice.

The freephone facility has been well received by patients. Callers have said that it makes calling from work easier. Staff have also noted that if patients call outside operating hours, they prefer to ring back rather than leave a message. People who work are most likely to ring from 5.30-7.30pm.

Staff at the call centre, which has links to Leeds Teaching Hospitals trust, ring parents to confirm that their child will be attending for scheduled procedures at the trust in an effort to reduce nonattendance. The centre is also involved in the project to bring comprehensive electronic booking to west Yorkshire by 2005.

We have learned that ergonomics in the workplace is a vital consideration where many repetitions of movement occur.Workstations have been organised and reorganised to manage this situation.

Effective telephone headsets are vital to allow staff to operate the computers at the same time as answering calls. Being able to process calls quickly and efficiently is paramount to ensuring satisfaction for patients and staff.

Since the inception of telephone booking, almost 2,000 appointments have been made in the first six months and we expect further growth as new services enter the programme.

The staff team is enrolled in the European computer driving licence, which is proving invaluable when handling the large volume of data that is used daily. ECDL consists of seven modules covering basic concepts of IT, computer use and files management, word processing, spreadsheets, databases, presentations and information and communication.To gain the qualification, candidates have to take tests on each module at an accredited test centre.

We are also thinking of giving staff specialist training in call handling.

There are plans to improve the IT support system and position it ready for electronic booking.We are considering whether the centre should move to other premises which would facilitate a patient administration system connection to Leeds Teaching Hospitals trust.This could provide the foundation for electronic booking.

The role of the booked access centre will be reviewed and it could become the central point of referrals for the PCT. It could track referrals to both primary and secondary care.

We are seeking to expand the range of services being booked through the centre to include endoscopy and ear, nose and throat clinics.One of our aspirations is to develop a fully booked community hospital.

The model of a central contact centre for booking community services appears to be working well at this early stage.The impact on one service for which there is booking has been very positive so far.

We are confident of expansion to cover other services.Contact centres are a crucial supporting technology in the development of electronic bookings.We anticipate our early learning will be of great benefit as booking becomes the only way in which patients access local health services.

The booked access has the potential to become the lynchpin of the information held by the PCT, and a lot of consideration has gone into the type of information system we need.We maintain a close relationship with the IT team, which is progressing towards an integrated primary care system.To date, an interim solution has been identified, using a Microsoft Access database and developed in collaboration with colleagues from Leeds Teaching Hospitals trust.

There is a great deal of enthusiasm within the organisation for the booked access centre and it has proved patient friendly.One of the most encouraging aspects of the scheme is the 'can do' attitude of the team involved.

Key points

A primary care trust has established a call centre for booking appointments for community services.

The service handles bookings for physiotherapy, minor surgery and retinal screening.

Since it went live in April 2002, the service has booked 2,000 appointments, reduced waiting times for physiotherapy appointments from 16 to four weeks and cut nonattendance rates from 18 to 2 per cent.

It is hoped to increase operating hours to 7.30pm and extend to cover other services.

John Pattinson is programme manager, access booking and choice, South Leeds primary care trust.