Q Exchange
Your Surgery-Your place, your date
- Proposal
- 2023
Meet the team
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
When you book a car servicing or MOT, you enter car registration and post code and get a choice of slots available as near or as far as you want. Similarly for standard day surgical procedures like varicose veins, Hernia, or Arteriovenous fistula creation for Haemodialysis the hospitals could make dates available on-line for patients to choose, click and book a date that suits their needs. When surgeons book patients for surgery on the electronic patient records they click on those suitable for a pooled list. These patients rather than wait weeks or months to receive a phone call or a letter regarding a date at their own hospital and then trying to re arrange their lives around that date, could choose to book any suitable available slot in any other participant Network hospital.
What does your project aim to achieve?
As a CQC specialist adviser for over 8 years I have visited a number of NHS and Independent hospitals and have noticed a wide variation in theatre capacity utilization from <50% to over 90%. The NHS benchmarking data shows national average of around 80% . What if every hospital created a list of theatre slots for standard surgical day case procedures like varicose vein, hernia or renal access surgery and made slots available on an open platform for patients to access and book themselves. It could start small with local hub and spoke network hospitals, expand to regional network like South East Vascular network (SEVN), and further expand to a PAN London initiative. This would go a long way to reduce health inequalities as anyone anywhere can book a slot irrespective of their postcode.
How will the project be delivered?
The key steps to the project are.
1. As network hospitals agree to a pooled list of patients that can be offered surgery at any centre.
2. Appoint a theatre co-coordinator to have access to this pooled list.
3. Create a standalone software on the likes of existing commercial models for car servicing and MOT to show the names of the participant hospitals and their available lists and slots.
4. If participant hospitals do not want to give their existing NHS slots to the pooled list for people outside the region, Integrated care boards could be asked to fund regional weekend lists at designated Hospitals onto which these patients could book in.
5. In future once we have shown proof of concept this software could link into the hospital records and automatically populate the patients from the pooled lists.
How is your project going to share learning?
In future once we have shown proof of concept this could be rolled out to all NHS hospitals and have a nationwide repository of slots available to be booked by anyone.
The same principle could be expanded to any of the following and many more:
1. Outpatient clinic bookings,
2. Scan booking
3. Community nurse booking
4. Physiotherapy booking
5. GP slots booking
How you can contribute
- Is it too ambitious to expect all hospitals to align and agree to the pooled list/ services concept.
- If not how to convince the ICBs to fund extra weekend lists for these pooled patients.
- During Covid, as a pan London Group we had discussion regarding patients needing AV Fistula creation for dialysis to go across to other centers for the procedures.
- How does money follow the patient?
Plan timeline
| 30 Sep 2023 | Recruit Post. Creat software Spec |
|---|---|
| 1 Dec 2023 | Beta version trial of software by patients on the list |
| 1 Mar 2024 | Refine and finalise tech based on feedback |
| 1 May 2024 | Analysis. Scale phase |
Comments
Sapna Shah 24 Mar 2023
A great idea Raghvinder which focuses on improving the experience for patients and making the process efficient. As others have already said, this could be a model for further treatments/ services. Good luck!
Debbie Williams 22 Mar 2023
This excellent concept would be beneficial on many levels:
- Patient involvement, choice and control; all these aspects would reduce DNAs and wasted slots as patients would be able to access appointments more suitable to their needs
- There is the opportunity for pooled lists to increase theatre capacity at participating centres. Also from my experience patients don’t have an issue with surgeon other than the clinician they’ve seen perform their surgery once pooling has been adequately explained
- Weekend list availability contributes to the government’s plans for the NHS to provide 7-day services, which has organisational and patient benefits. Participating in varicose veins procedure and outpatient lists I have seen how suitable this is for patients and the ease they have in navigating work and personal commitments plus how grateful they are for the available service. The Trust’s waiting list was also significantly reduced.
- Multi centre working would increase facilitating joint audit, benchmarking etc.
The only drawbacks could be securing participation from other institutions and the size of the project budget.
Abdullah Thawabeh 21 Mar 2023
reading through the project details, it presents an innovative approach to streamline surgical bookings and better utilize hospital resources, with the potential for broad impact and adaptability to various healthcare sectors. It showcases versatility and addresses health inequalities. The concept, inspired by other industries, has the potential to revolutionize appointment scheduling across the entire healthcare sector, greatly benefiting both patients and healthcare providers alike.
one thing to be addressed here is the privacy of the patient data being processed via that software, which I'm sure that the team is aware of. Thank you!
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Abdullah for your comment. I agree patient data security will be paramount.
Alexandra Rankin 21 Mar 2023
A great concept! Looking forward to hearing more about it.
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Alex for your comment. This builds on upon our shared experience from Covid-19 times when we had regular Pan-London renal access meetings and willingness to help each other with theatre capacity. The same needs to be restarted to tackle the waitlists in the region.
Rob Elias 21 Mar 2023
Hi Raghvinder,
This is very interesting.
Have you linked with Ben Lindsey, Clinical Lead for the London Kidney Network Vascular Access workstream? It would be great to join up this work with LKN work on vascular access pathways and shared capacity.
Rob
Clinical Lead, London Kidney Network
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Rob for your comment and suggestion to join up with Ben Lindsey, Clinical Lead for the London Kidney Network Vascular Access workstream. During Covid-19 times we had regular Pan-London renal access meetings and willingness to help each other with shared theatre capacity. This project will build upon our shared experience.
hiren mistry 20 Mar 2023
This is an excellent concept in principle and has the potential to tackle long waiting lists within the NHS and maximise theatre utilisation.
It also has massive potential to be rolled out to other specialities.
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Hiren. Yes the possibilities are endless. We just need to start the ball rolling and show the proof of concept
Hani Slim 20 Mar 2023
Excellent idea and truly if implemented correctly, most certainly may lead to major improvement in streaming or waiting lists.
Although I agree with other comments that the 40k is not a lot , but more importantly is to set and start the project.
Wish you all the best
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Hani for your comment. Yes 40 K is nothing, but still enough to show a proof of concept. If the pilot is successful then we can bid for higher amount of grants
Shail 20 Mar 2023
It seems like a great idea to give a bit freedom of choice to the patients to pick and choose the days they like and may help in reducing the cancellations if they get their favoured date. Is there a scope of prioritisation or would it just be on first come and first choose basis only?
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you Shail for your comment. The present Pilot will show the proof of concept, but yes, the final version should allow more filters.
Domenicoi Valenti 20 Mar 2023
It is a fantastic project and we need to collate all the available resources in order to utilise all available capacity. Also it will be a great tool that will definitively improve patient journey and experience.
Raghvinder Pal Singh Gambhir 21 Mar 2023
Thank you for your insight Dom. There needs to be a greater investment in service delivery and better ways of utilising capacity. It will be great if we had a couple of slots available for pooled patients on your weekend list in future. I am sure the ICBs will come on board and support it as well.
Rebecca Tulk 7 Mar 2023
I think the key here is to bring in the right technical partners and make sure the data sharing permissions are in place. I can put you in touch with some agencies who can help with accurate costing and sage advice
Raghvinder Gambhir 11 Mar 2023
Dear Rebecca
You are absolutely correct that data sharing permissions will be the key. I welcome your offer to put me in touch with agencies who can help with accurate costing and advice. Thank you
Joel Reynolds 2 Mar 2023
I like the idea/ambition, and can see how it could bring benefits of reduced waste.
But wonder how this might affect people with low digital literacy and what steps would need to be in place to mitigate risk of worsening access for certain groups.
Raghvinder Pal Singh Gambhir 5 Mar 2023
Dear Joel
Thank you for your comment. I agree people with low digital literacy may find it daunting to do it on their own. For them the clinician or the clinic co-ordinator admin person can help them look at the site while in the clinic and book the next available suitable date at the time of the consultation itself.
Dimple Keen 1 Mar 2023
Whilst I like the concept of the idea, and as a patient would strongly advocate for this, the reality is that this would be very hard to achieve. This is essentially choose and book, but for surgery. £40k just won't be enough to see this through. What I often come across is that patients become attached to the clinician they meet in clinic - and will therefore wait to be treated by that person. So the ideal scenario is that the patient gets seen in opd by the person who will operate on them. If we go with what you've suggested, there is potential for a second opa for the patient which is inefficient. I also think there are too many IT barriers. I genuinely hope we can get to this, but don't think the infrastructure is there yet
Raghvinder Pal Singh Gambhir 5 Mar 2023
Dear Dimple, Thank you for your comment. Yes for major procedures like aneurysms or a bypass surgery a patient would like to go to the same surgeon who has been seeing the patient in the clinic. But for many day case procedures we already run a pooled list like for varicose veins, Arterio venous fistula (AVF) creation for patients needing to start dialysis. At the consultation in the clinic the patient is asked if the patient is happy to be on the pooled list and I have seen that >80% are happy. During Covid-19 we tried to get a pan London AVF creation spreadsheet and patients were willing to travel.
All hospitals now book patients electronically and we have to click yes or no to the question whether patient is suitable for a pooled list.
Technology to create a master booking site exists, the barrier will be linking to each hospitals electronic patient record. For the purpose of this project this pooled list will be collected manually by the theatre co-ordinator and made accessible to patients to pick their place and time.
Biba Stanton 1 Mar 2023
I think it will be interesting to learn about what barriers you face in trying to work across organisations in this way - this knowledge could then by applied to other projects seeking to poor resources to improve access
Raghvinder Pal Singh Gambhir 5 Mar 2023
Dear Biba
You are absolutely right to suggest that we need to identify barriers that will prevent us working across organisations. Luckily because of Covid there has been a greater collaboration and at present we are already in talks to help each other with long waiters. The present project will foucs on day case procedures or office-based procedures which do not require in patient stay. Varicose vein procedures and Arterio-venous fistula creation for patients staring Haemodialysis are ideal. For the latter there were pan London discussions during Covid-19, and we will build on those to make it happen.
Beckie Burn 1 Mar 2023
It would be good to connect this to conversations in APCs about developing shared PTLs within London systems
Raghvinder Pal Singh Gambhir 5 Mar 2023
Dear Beckie
You are spot on. In future there should be shared PTLs among the participant hospitals. In an idealistic future it should cover all NHS hospitals. Like when a booking for a driving licence test you can book yourself a test anywhere. Similarly you should be able to book your surgery anywhere you can reach. Initially we will have start with the network hospitals, Pan London region and gradually build it up to cover larger geographical area.
John Lodge 28 Feb 2023
This is one of those common sense solutions that should exist already. If this is the first attempt at digitising this it could have huge potential for patients across London in this service.
Raghvinder Pal Singh Gambhir 5 Mar 2023
Dear John
Thank you
It is the first for surgery and if we can show the proof of concept for a couple of standard day case procedure then there is a huge potential for it to be rolled out across all specialities.
Cheryl Levy 1 Mar 2023
Agreed. Definitely a common sense solution. This is something that could make a difference to all communities throughout London. I look forward to seeing this progress as well as benefiting from it.
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