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Section 2: fast and easy access  
 

2007/10 objective: Treating our patients on time, every time, and in the most appropriate setting 

Close working with other local healthcare providers, including GPs is crucial to our strong performance

Barts and The London continues to perform well against national targets and priorities and is currently the top-rated teaching trust in England, according to the Healthcare Commission’s annual health check (click here for more information).

Crucial to our strong performance is continued close working with other local healthcare providers, including primary care colleagues and those in neighbouring hospitals or in sector-wide clinical networks.  Such work is also vital in ensuring that patients are seen by the appropriate clinical professionals in the right setting at the right time, and reflects national policy to shift more care to community settings, rather than hospitals.

Between May and September 2006, GPs across north east London were invited to give us their views about Barts and The London’s services, and how they could be improved, in an online survey.  The results are now helping us to focus on the issues of greatest importance to GPs and, by association, to their patients.

This section looks at some of our initiatives to speed up and make easier patients’ access to our services, including joint working arrangements with partner organisations.

Streamlining services

As part of our Best Value programme (click here for more information), we continue to streamline patient access to care at all stages to eliminate delays or cancellations, and reduce the time needlessly spent in hospital. This benefits both the patient and the hospitals, creating savings and helping us to make better use of beds.

Treating patients within 18 weeks

Community dental services will be enhanced in January 2008 following the opening of the new Barkantine healthcare facility on the Isle of Dogs

One of the biggest challenges facing all NHS trusts is that all patients must be seen and treated (or a decision made not to treat) within 18 weeks of referral to hospital by December 2008.

To prepare for the new target, Barts and The London is working with Tower Hamlets Primary Care Trust to develop a common approach to patient pathways and models of care across primary and secondary care, increasing patient satisfaction by reducing the frustration and worry of waiting for diagnosis and treatment, and reducing staff frustration by removing unnecessary delays in the patient pathway. Understanding whether referrals to hospital are appropriate and working with referrers where they are not will be key. 

Improving discharge information

The importance of prompt and legible discharge letters was highlighted by almost 60 per cent of respondents to our GP survey, and is an area where improvements have been made in the past year.

Our electronic system for discharging patients (e-TTA) is in place for the majority of inpatient wards across our hospitals, replacing traditional hand-written forms.  E-TTA provides an electronic record of discharge information in the electronic patient record (EPR), and ensures that the information on the form is complete and legible.  All doctors, nurses and pharmacists at Barts and The London who are involved in discharging patients are now being trained to use the new system.

Co-ordinated emergency care

Barts and The London is part of a sector-wide urgent care network, which aims to ensure that patients who need emergency treatment are seen by the right professionals as quickly as possible.  Close working with our colleagues at the Whitechapel walk-in centre and the presence of primary care practitioners in our A&E department at The Royal London helps to make sure that only those patients who need to receive care in hospital do so.  In September 2006, we contributed to Tower Hamlets Primary Care Trust’s Local Heroes campaign, which raised awareness of alternatives to A&E for urgent health advice, including nurse practitioners, GPs, pharmacists and walk-in centres.  

Better access

New community centre for maternity and dental services   

Work has begun on a £11 million new healthcare facility – the Barkantine – on the Isle of Dogs, providing better and more local services for residents, at the same time as responding to the increased demand for maternity and dental services, particularly from the new Thames Gateway development. 

The midwife-led birth centre, due to open in December 2007, will have five multi-purpose rooms, each with a birthing pool and ensuite facilities, and will provide all aspects of care and support for local women with low-risk pregnancies before, during and after their baby’s birth. The new dental unit, which will include a teaching centre for dentists, will provide free NHS dental services and is scheduled to open in January 2008. 

The new centre, which will be run jointly by Barts and The London and Tower Hamlets Primary Care Trust, will also provide space for nine GPs, a family planning clinic and counsellors, as well as offering a base for health visitors and school nurses, a team to support children with disabilities, a children’s centre and the local community mental health team.

Community focus for long term conditions

Barts and The London’s joint long-term conditions work with Tower Hamlets Primary Care Trust concentrates on diabetes, heart failure, chronic pain and children’s asthma, aiming to deliver care in the community where possible, instead of in hospital.  In the past year, the diabetes centre at Mile End has made significant strides in developing stronger medical and nursing outreach support services to local GP practices, while patients with heart failure who come into hospital initially are followed up at home to reduce the risk of readmission and to ensure close links with GPs and practice nurses to develop management plans. 

More convenient dialysis for renal patients

Community outreach support services include heart failure clinics at The London Chest Hospitals

In response to feedback from renal dialysis patients, Barts and The London has introduced a series of early evening appointments to complement the existing nine-to-five weekday service. As well as giving patients more choice of appointments and better access, the service also makes better use of our hospitals’ dialysis equipment.

All patients offered choice of appointment

All patients who need an inpatient, outpatient or day-case appointment at Barts and The London can now choose a mutually convenient date and time following the introduction of the Choose and Book system, which also gives patients options on where to be treated.  Those who select our hospitals speak to specially trained staff in our appointments centre and are offered dates and times for appointments.  GPs then send a referral letter to the relevant specialty at our hospitals.  Since its introduction, there has been a dramatic increase in the number of patients being referred to Barts and The London through Choose and Book, with 16,931 referrals through the new system during 2006 compared to 405 in 2005. 

Improving patient transport

A new assessment and booking system, introduced in March 2007, aims to improve the reliability and punctuality of non-emergency patient transport to and from all our hospitals, at the same time as reducing the number of unnecessary journeys. Patients who request the service are now assessed by staff in a centralised travel facility to ensure fair and consistent application of the eligibility criteria, prioritising those with the greatest need. The new system also removes the need for clinicians to book transport for their patients, allowing them to focus on clinical priorities.   

Performance against national access targets 2006/07

What we promised for 2006/07

What we achieved

Additional information

All patients will be seen within two weeks of an urgent GP referral for suspected cancer to first outpatient appointment

Achieved

We have consistently achieved this target since its introduction in 2004/05

Suspected cancer patients will be seen within one month from diagnosis to treatment

In March 2007, we achieved the target – for the whole of 2006/07, we had a 99.8% success rate

Performance in this area has improved by almost 4% in 2006/07

Suspected cancer patients will be seen within two months from urgent referral to treatment

For the whole of 2006/07, we saw 92.5% of patients within the target time

Our performance against this target has improved by 12% since 2005/06, and by April 2007, 95.8% of patients were seen within the target time

Patients will wait no more than 26 weeks for admitted patient care

Achieved

The target for 2007/08 is 20 weeks, which we achieved in April 2007, putting us on target for the more stringent 18-week target that must be achieved by December 2008

Patients will wait no more than 13 weeks for an outpatient appointment

Achieved

The target for 2007/08 is 11 weeks, which we met in April 2007

All patients will be able to choose a convenient date and time for their first outpatient appointment 

Achieved

Referrals via the electronic Choose and Book system, which also gives patients a choice on where they are treated, rose significantly, from 405 in 2005/06 to 16,931 in 2006/07

The maximum wait in A&E (from arrival to admission, treatment/ transfer or discharge) will be four hours for 98% of patients

Achieved

98.3% of patients were seen within the four-hour target in 2006/07

70% of patients who need access to sexual health and GUM clinics will be seen within 48 hours

Achieved

We are one of the few trusts nationally to consistently achieve this target – in fact, 100% of patients who require these services at Barts and The London are seen within the target time

Keep cancellations of operations for elective admissions to anabsolute minimum

Only 1.38% of elective operations were cancelled in 2006/07

By May 2007, the number of cancelled operations was at its lowest level for more than 12 months