Service Specification No. Service Commissioner Lead Provider Lead. Period 1 st April st March 2015 Date of Review September 2014

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1 Service Specification No. Service Commissioner Lead Provider Lead Paediatrics ENT Period 1 st April st March 2015 Date of Review September Population Needs National/local context and evidence base There are a large number of patients treated for ENT conditions every year. It is estimated that approximately 8,000 ENT appointments are attended every year. Reducing unnecessary referrals into secondary care could prove to be cost effective, as well as delivering high-quality care in the community and increasing patient choice. The NHS plan identifies that there is scope to develop better services within primary care: a significant number of ENT conditions can be seen within primary care. Capacity within the local acute trust will be freed up as a result of successful triage within the community and enable them to focus on more complex cases. The service will be in line with QIPP program of Planned Care and pathway transformation and will: o o o o o provide quality care closer to home enhance intermediate care provide local access to treatment in primary care reduce re-attendance for patients ensure value for money 2. Outcomes The expected outcomes of the service are: Reduced number of ENT referrals into secondary care Provision of a one-stop shop for patients All patients requiring an appointment to be seen within four weeks of receipt of referral Patient requiring onward referral into secondary care to be forwarded within two working days of appointment Choice of secondary care provider to be offered impartially (to be picked up through patient satisfaction survey) Equity of service provision across Ashford CCG Performance indicators will be developed and improved over time and may be added in agreement with the service provider through the performance review meetings The service will be monitored against the key performance indicators on a monthly basis by the commissioner and the service manager Interim monitoring will be via the collection of data, which will be made available monthly to the relevant personnel with the CCG. The expected outcomes of the service are:

2 Reduced number of ENT referrals into secondary care Provision of a one-stop shop for patients All patients requiring an appointment to be seen within four weeks of receipt of referral Patient requiring onward referral into secondary care to be forwarded within two working days of appointment Choice of secondary care provider to be offered impartially (to be picked up through patient satisfaction survey) Equity of service provision across Ashford CCG Performance indicators will be developed and improved over time and may be added in agreement with the service provider through the performance review meetings The service will be monitored against the key performance indicators on a monthly basis by the commissioner and the service manager Interim monitoring will be via the collection of data, which will be made available monthly to the relevant personnel with the CCG. 3. Scope Aims and objectives of service The specification sets out the requirements for the provision of a primary care ENT service for patients registered with a GP within the following CCG s: Ashford, Canterbury and Coastal, South Kent Coast and Thanet. Primary Aims Provides a high quality, effective, safe service provided by suitably qualified practitioners. Supports and encourages innovation Reduces health inequalities and improves the health and quality of life of the population Provides a locally accessible ENT service in primary care for patients registered with a GP Practice within the following CCG s the following CCG s: Ashford, Canterbury and Coastal, South Kent Coast and Thanet. Meets the 18 week referral to treatment (RTT) target Supports patient choice and where appropriate provides ENT diagnosis and treatment services closer to home Develops referral guidelines to encourage appropriate GP direct referrals and identify referral threshold into secondary care Assists GPs to manage ENT procedures in General Practice Provides additional capacity within the Local Health Economy thereby reducing demand in secondary care for ENT Is sensitive to needs of individual patients and delivered in a timely and efficient manner. Ensures that patients are on the appropriate pathway, enabling them to be seen by the correct healthcare professional first time, without delay Enables earlier intervention of treatment, with better and consistent outcomes Reduces the number of appointments for patients, minimizing unnecessary follow ups Enables earlier intervention of treatment, with better and consistent outcomes Objectives The objective of the service is to reduce demand into secondary care ENT services by managing patients conservatively within Primary Care. As a result there will be a reduction of unnecessary referrals into the acute hospital setting, driving down waiting times and delivering care closer to home. The service will allow patients to be appropriately diagnosed and treated in a community setting within a timescale that will allow the 18 week referral to treatment target to be achieved.

3 The organisation and partners should work together to provide quality assured services and drive forward continuous improvement. Multi-disciplinary teams should work to a continuously high standard and identify ways to provide safer and even better care for their patients. Service description/care pathway The provider of this service will provide this service to patients registered with a GP within the following CCGs: Ashford, Canterbury and Coastal, South Kent Coast and Thanet. The service does not include the management of suspected cancer referrals or children under 3 years old or adults over 16 years. Services are to be of a high quality, sensitive to needs and delivered in a timely manner. The provider will arrange for the delivery of health promotion and education to be given as appropriate in the course of the service provision and should co-operate fully in pursuing national and local health promotion initiatives. The service will be delivered by an ENT Consultant and will provide the procedures outlined in this service specification for patients who are eligible for the service. General practice actions: Triage by an ENT consultant/gp/nurse Practitioner. The service will operate on a one stop clinic basis offering clinical assessment, treatment and advice, reducing the need for additional follow ups, where appropriate Provide a full audiology assessment to patients referred into the service Provide a one-stop shop for patients All patients requiring an appointment to be seen within four weeks of receipt of referral Patient requiring onward referral into secondary care to be forwarded within two working days of appointment. The patient s GP will be informed of this referral and the rationale for it. Clear referral criteria will be in place to ensure patients are not referred that would normally be treated within a GPs core practice. The referring GP will receive written feedback following each consultation The provider will ensure that referrers adhere to the clinical pathways that have been or will be developed and are relevant to this service. Where appropriate the patient should give written consent for the procedure to be carried out in advance and the completed NHS consent form should be filed in the patient s lifelong medical record. All tissue removed by general surgery should be sent routinely for histology examination unless there are exceptional or acceptable reasons for not doing so. Histology results will be sent directly to the patient s GP and a copy requested for the provider held patient records. Where clinically appropriate, patients will be referred back to their GP with advice for on-going management in primary care. Referrals deemed to be incomplete or inappropriate shall be returned by the provider with advice to the GP. Professionals should regularly audit and peer review their work with the aim of continuously improving quality, efficiency and clinical effectiveness. The provider will keep adequate and contemporaneous electronic records for each individual patient detailing the reason for referral, diagnosis, examinations/treatment undertaken, outcome and, if appropriate, referral on to secondary care for advice/onward care. Information should be readily accessible and provided to the commissioner when required. Professionals should regularly audit and peer review their work with the aim of continuously improving quality, efficiency and clinical effectiveness. The provider will ensure that a summary containing advice on any necessary treatment be maintained in the patient s lifelong medical record. The provider is expected to maintain close communication with the Purchaser on matters relating to the Provider s services. The

4 principle point of contact on Service Agreement matters will be the Commissioning Manager. Response time and prioritisation Patients will be seen within 4 weeks of referral and contacted within one week once the referral has been received by the provider. The service will contribute towards delivering the 18 week referral to treatment national target for waiting times. Referrals deemed incomplete or inappropriate will be returned with advice to the GP within 2 working days of receipt. Where possible patients will be seen within 4 weeks of the referral being triaged and a treatment plan agreed Patients will be seen within 30 minutes of their appointment time. Delays will be communicated to patients and where necessary alternative appointments will be given within one week. Patients requiring onward referral to secondary care will be referred within 2 working days Appointments should be arrange quickly and at the convenience of the patient, including: Choice of date and time of appointment Confirmed in writing (with patients permission); date, time, location, information leaflet on what to expect on the day and other essential information. In each case the patient should be fully informed of the treatment options and the treatment proposed. Days/hours of operation The ENT clinics will run 2 sessions per week. At service commencement the service will run on the following days: ENT outpatient clinics; Monday and Tuesdays alternate fortnightly. For the avoidance of doubt, the times and days listed above are recognized by the Commissioner as being the days and times of operation at the commencement of the ENT outpatient service. It is not the intention of this contract to hold the Provider to these particular times and days of the week for the duration of this contract as it is recognized that the exigencies of the Provider and in particular the needs of their patients may render appropriate that the timing and frequency of such clinics may have to change from time to time. Although it is required that this ENT service will run twice per week, it is not expected that the service will necessarily run on days that coincide with Public Holidays, although the Provider will be required to ensure that any waiting time targets that apply to this service, either by local or national waiting time requirements, are not breached as a result of any such service interruption caused by Public Holidays. It is a requirement of this contract that clinics start on time and that patients are seen promptly at their appointment time, if they have arrived on time. Population covered Patients registered with a GP within the following CCGs: Ashford, Canterbury and Coastal, South Kent Coast and Thanet who is eligible for a procedure identified in this service specification. Any acceptance and exclusion criteria

5 Acceptance Criteria In accordance with the core competencies for Practitioners with a Special Interest in ENT, the clinic will accept referrals for patients with: Acute Otitis Media Recurrent tonsillitis Epistaxis Rhinitis Nasal Obstruction Deafness Rhinnorhoea Dysphagia Vertigo/dizziness Hoarseness Otalgia Neck swelling Patients requiring Micro Suction (agreed minor ear procedure tariff can be charged). Where more than one procedure is carried out at a clinic appointment only one procedure tariff can be claimed. Exclusions (please see below) Patients who require emergency treatment Patients not registered with an Eastern and Coastal Kent GP In accordance with SIGN Guideline 117, patients should not be referred into the service with: Sore throat associated with stridor or respiratory difficulties. These patients should be referred to secondary care. The service will not undertake any procedures from the exclusions listed in this specification unless there is a clear clinical need. Referral criteria and sources This service follows the Referral and Treatment Criteria. Patients who do not meet these criteria will not be routinely treated. Referrals will be permissible to come from GPs, Nurse Practitioners, Health Visitors, and the community audiology team. Referral processes Referrals into the service will be made using agreed referral pro-forma, the provider will include their services on Choose and Book but will have the ability to accept paper or referrals. All referrals into the service must be fully completed by the referrer with patient demographics and relevant medical/drug history and any other supporting information. Referrals deemed suitable for an alternative service will be signposted accordingly with feedback provided to the referrer. Referrals deemed incomplete or inappropriate will be returned with advice to the referrer within 2 working days of receipt. The referrer will be advised of the outcome of triage and summary of proposed care plan within 2 working days of decision on referral. Any onward referrals into secondary care will follow national Choose and Book guidance. The service is subject to the 18 week referral to treatment target. A minimum data set will be completed for each onward referral clearly showing the 18 week clock start information. This will be sent through electronically to the secondary care provider.

6 Exclusions Children aged 3 and under and adults aged 16 and over. Urgent suspected cancer referrals Conditions requiring Computed Tomography (CT) or Magnetic Response Imaging (MRI) where a competitive direct access price has not been negotiated. The service is not available to patients who require emergency treatment. Some conditions can require further investigation such as CT or MRI. The conditions usually are but not limited to: Condition Chronic Rhinosinusitis Sensorineural Hearing Loss Nasal Obstruction Dysequilibrium Unilateral Tinnitus Investigation CT CT/MRI CT MRI MRI Given the additional cost for CT and MRI when requested by a GPwSI rather than being part of the acute trust first appointment tariff, a recommendation would be that either: Patients with this suspected diagnosis should be referred directly to the Acute Trust The cost of direct access CT and MRI be negotiated to enable GPwSI s referring for these conditions to do so at a competitive cost. It is expected that if referrals are received for excluded procedures the provider will advise the referring GP. Should the exclusion not be apparent until the patient has been seen then the provider should contact the patient s GP directly. Discharge processes All patients are to be given verbal and written post-operative instructions including (whether discharged to GP, self-care or onward referral to secondary care): Access to staff at surgery where procedure was performed should they require further advice Return to surgery for further care and/or treatment For serious complication, immediate appointment and access to Consultant. If the procedure is unsuccessful, the patient will be invited for a re-operation at no extra cost to the Commissioner. A letter of notice of discharge is to be sent to the GP within 2 working days of the treatment which includes diagnosis, management and recommendations. If a patient presents again for the same condition within 6 months they will be classed as a follow up and not a new appointment. Interdependencies with other services The service will need to have good links with other practices, have the appropriate premises and staff should be trained and competent and meet required standards. Whole system relationships The service relies on the provision of clinical expertise to triage referrals and deliver an effective clinical service in the primary care setting. It is recognised that the practitioner may need to seek specialist advice and guidance for some patients. Close working and relationships with ENT consultants within secondary care

7 will be developed and maintained to support this where required. The service will have, and further develop, positive working relationships with all relevant parties. Prescribing The provider will be liable for costs allocated to the providers prescribing code and reimburse this cost to the CCG on invoice. Providers are to develop formulary for items which will impact on primary care prescribing referred to as a Primary Care Formulary and submit to CCG prescribing forum for approval. Requests to GPs to initiate or continue prescribing from the provider will be within the Primary Care Formulary. Prescribing outside of the Primary Care Formulary will remain as the responsibility of the provider Providers will develop shared care agreements where required by GPs and submit to CCG prescribing forum for approval. Providers will continue to prescribe medication under shared care until accepted by the GP Use of medication excluded from payment by results will be applied for through the CCGs process (e.g. MM1 form) in line with the requirements of the Health Economy High cost drugs- summary of current arrangements available at Providers will provided GPs with access to patient s test results where required for shared care If Patient Group Directions (PGDs) are required, providers will develop them within the CCGs framework. Providers will have an auditable process to support robust clinical governance for use of medication within their service and supply results of audit to the CCG on request. Personal Health Budgets Not applicable to this service. Prevention, self care and patient and carer information The Provider must develop a suitable patient leaflet, agreed with the Lead Commissioner, giving details of how to access the service, patient bookings and service location. The patient leaflet must give detailed information about any pre-test preparation which is required and explain what the patient can expect. The leaflet must also give information in relation to complaints procedures. The Provider must provide patients with (unless determined to be clinically inappropriate) clear information and feedback on the outcome of their procedures and how information will be fed back to them on the outcomes. Evidence based Information and advice regarding treatment will be made available on an individual basis to meet the needs of the patient, and provision of education to support the patient in self management of their condition The provider will provide appointment confirmation letters to the patient that contain or have attached, contact details of and directions to the site where the appointment is to be held along with the relevant patient information leaflets relating to that appointment. Information provided about services will be in a range of accessible formats taking into consideration issues of language, disability and literacy levels. Service users must be able to access appropriate interpretation services such as language and British Sign Language (BSL).

8 The provider shall be responsible for ensuring that all patient communication written or verbal is available for patients in the appropriate language required. The provider shall ensure the privacy and dignity of patients is protected at all times, including having measures in place to chaperone patients when this is requested. Providers shall organise patient transport for all patients meeting agreed eligibility criteria. This is in line with updated Department of Health guidance and the policy direction set out in Our health, our care, our say which entitles all eligible patients referred by a health care professional for treatment in a primary care setting, and who have a medical need for transport, to receive access to Patient Transport Services and Hospital Travel Costs Scheme. 4. Applicable Service Standards All services provided should comply with Kent and Medway Referral and Treatment Criteria (RaTC). The CCG reserves the right not to reimburse providers who treat patients who fall outside of these criteria which may change from time to time. Applicable national standards e.g. NICE, Royal College The Provider must comply with: Care Quality Commission Standards the revised hygiene code, The Health and Social Care Act 2008, Code of Practice for the NHS on the prevention and control of healthcare associate infections and related guidance; relevant standards to assure safeguarding of vulnerable adults, and in particular to: ensure all staff in contact with, or accessing data about, vulnerable adults have enhanced CRB checks work with the Commissioner to develop a phased adult protection training plan for staff adhere to the Commissioner s procedures, protocols and guidance on Adult Protection embed learning s from Serious Untoward Incidents into internal procedures and protocols adhere to the requirements of the Mental Capacity Act 2005 (amended 2007) The Provider must comply with the following regulations and legislation: Equal Pay Act 1970 Sex Discrimination Act (as amended) 1975 Race Relations Act 1976 (as amended by the Race Relations (Amendment) Act 2000 Disability Discrimination Act 1995 (as amended) 2005 Human Rights Act 1998 Sex discrimination (Gender Reassignment) regulations 1999 Employment Equality (Religion and Belief) regulations 2003 Employment Equality (Sexual Orientation) regulations 2003 Gender Recognition Act 2004 Age Discrimination Regulations 2004, and Equality Act 2006 (Gender Equality Duty) The legislation requires public organisations to demonstrate specific duties in relation to the legislation. The Provider must publish these schemes within the public domain and provide evidence of the sensitivity and accessibility of Service, including providing of information on service usage by patients under the following categories: ethnicity age

9 gender/sexual orientation disability religion and belief provide evidence in relation to the staff employed by the organisation, including providing information on workforce composition under the following categories: age ethnicity gender/sexual orientation disability This evidence must be published within the annual report of the organisation. Applicable local standards Payments will only be made upon receipt of the required information reported on a monthly basis using a monthly reporting sheet. The monthly data to be submitted to for each patient attendance is as follows: A record for each case which includes: Patient Identifier i.e. NHS number or name, date of birth and postcode Patient ethnicity, date of birth, gender and disability Postcode of patient s usual residence Registered GP and practice of patient Date referral received Date referral triaged Urgency of referral Reason for referral Outcome of triage Date patient was seen Attendance indicator Diagnosis Procedure carried out Area of body treated Was treatment first definitive treatment Clinician undertaking procedure Outcome UBRN of patients referred to secondary care Reason for referral to secondary care A record of: Risks / incidents A quarterly assessment of: Patient feedback / satisfaction with the service It is recommended that the provider follows the NHS Data Dictionary and the Organisation Data Service for its recording of cases. If another coding mechanism is used the definitions must be provided to the CCG. The use of free text fields will not be accepted. The data must be sent from an nhs.net address to meet information governance requirements. A monthly summary of risks and incidents and a quarterly assessment of patient feedback /

10 satisfaction with the service must also be provided. Indicators and measures will be developed and improved over time but will include: performance monitoring through the issue of a monthly performance report (to be received by the Commissioner by the 10th day of the following month) and quarterly meetings between the Provider and Community Contracts Manager. Where the Provider has not achieved targets, the Provider must explain the reasons and the actions it will take to rectify the non-achievement; ensuring that evidence is provided in relation to where the Provider will recruit the staff who will operate these services, for example whether newly qualified staff, staff already employed elsewhere by the Provider, or experienced staff newly recruited from the local health economy. The service must deliver the aims detailed above and must: provide a high quality service that reflects best professional practice reduce the necessity for patients to attend secondary care outpatient clinics provide both formal and informal education to promote effective clinical expertise, and comply with all relevant policies and procedures. In addition the Provider shall: screen all referrals within 2 working days of receipt identify outcome measures, agree them with the Commissioner, and implement them before the commencement of service send discharge summaries to the patient s GP, electronically, within 2 working days include patients in service satisfaction questionnaires, with an anticipated response rate of 60%, and which are used as part of the audit cycle, with action plans to be developed from findings monitor any missed appointments and service induced delays and develop with action plans from findings ensure all clinicians within the Service maintain professional registration, adhere to professional codes of conduct at all times and follow agreed protocols within the service assess each clinical area regularly to ensure hazards are minimized Ensure every patient has access to a local provided consultant-led service, where necessary achieve a maximum wait of 18 weeks from referral to first treatment with effect from service inception comply with all relevant medical devices directives (Medicines and Healthcare Products Regulatory Agency) protect the privacy and dignity of patients at all times, including having measures in place to chaperone patients if this is requested comply with the Health and Social Care Act (2006) Part 2 (Prevention and Control of Healthcare Associated Infections. There must be infection control procedures and protocols including decontamination which must comply with NHS standards. This will include: staff must attend annual infection control training peer audits on hand hygiene must be carried out practitioners hands must be washed between patients the probe must be appropriately cleaned between patients the couch used must be wiped clean between patients demonstrate compliance with all applicable Health and Safety legislation

11 have in place a comprehensive risk management policy and systems for incident management. The Provider must notify SUIs (serious untoward incidents) to the Commissioner and the Medical Director at the earliest opportunity and within a maximum of 24 hours of each occurrence. The Provider is responsible for investigations of any incidents and must submit reports of investigations of SUIs to the Medical Director within 45 days of the initial notification. The Provider must report incidents and complaints to the commissioners every three months have in place a whistle-blowing policy provide information to patients in the form of patient information leaflets which can be sent out with appointments comply with NHS standards for record-keeping, Caldicott principles, data protection law and the common law duty of confidentiality have in place a complaints procedure and process which is advertised to patients and meets NHS standards have in place written protocols and procedures for receiving referrals and for undertaking the investigation, as well as reporting back to the referrer have in place to receive and implement promptly, any national safety alerts meet all its duties under current Health and Safety legislation Clinical Standards The following clinical standards are applicable to this service: SIGN Management of sore throat and indications for tonsillectomy SIGN 66 - Diagnosis and management of childhood otitis media in primary care NICE CG60 surgical management of otitis media with effusion in children Information technology support If diagnostic images and medical records are shared across a network of experts to ensure timely diagnosis, the Provider must ensure that the appropriate infrastructure to support such sharing is in place. Additionally, the Provider must ensure that such data sharing is appropriately secured in line with national guidance. The Provider must ensure that maintenance and calibration is carried out to the manufacturer s specification with the cost being borne by the Provider. The Provider shall provide appropriate IM&T systems to fully support the Service requirements. IM&T systems means all of the IM&T related infrastructure, computer hardware, software, networking, training and maintenance necessary to support and ensure effective and secure delivery of the service, management of patient care and contract management. It is the responsibility of the provider to ensure that the IM&T systems are maintained and are kept fit for purpose. The Provider s IM&T Systems must comply with the following standards as appropriate to the services commissioned from the Provider: GP Systems of Choice (GPSoC) programme; National Programme for Information Technology (NPfIT); Referrals and booking; NHS Terminology Service. The Provider must use a clinical system that is compatible with clinical systems approved under the GPSoC programme. The NHS Operating Framework 2010/11 directs those working in medical care services to the specification that NHS Connecting for Health (CfH) has issued which sets out the requirements for IM&T systems and infrastructure needed to support clinical applications in

12 use in primary care, now and in the future, including the GPSoC programme. The Provider must cooperate with all parties (the Commissioner, local service providers, national application service providers, national infrastructure service providers etc.) that are responsible for implementing the NPfIT. The provider will be required to use those elements of the NPfIT that are appropriate to the service. The IM&T systems that are part of the NPfIT include: Choose and Book: the national electronic referral service giving patients choice of place, time and date of their first outpatient appointment will be the mechanism used for all referrals and appointments N3: use of the national network, as a third party user, for all external system connections to enable communication and facilitate the flow of patient information NHS Care Records Service (CRS): use of CRS to ensure that all patient records are kept in the national compatible format and when available to communicate with the national spine services, including access to and use of the Summary Care Record (SCR) Electronic Prescription Service (EPS): use of the electronic prescribing service for supply, administration and recording of medications prescribed and transmission to the Prescription Pricing Division (PPD) GP2GP: use of GP2GP so that patient records are transferred electronically when a patient registers with a new practice Personal Demographic Service (PDS): use of the PDS to obtain and verify NHS Numbers for patients and ensure their use in all clinical communications NHSMail: use of the NHSMail service for all communications concerning patient-identifiable information, and Quality Management and Analysis System (QMAS): use of QMAS to demonstrate performance against QOF achievement targets to support quality improvements in services provided to patients The Provider s IM&T Systems must be effective for referrals and bookings including appointment booking, scheduling, tracking, management and the onward referral of patients for further specialised care provided by the NHS, independent sector or social care and must be compliant with Choose and Book requirements. The Provider must comply with NHS Terminology Service (NHS TS), NHS Classifications Service (NHS CS) and Healthcare Resource Groupings (HRG) including: Read Codes and migrate to SNOMED NHS Dictionary of Medicines and Devices Office of Population Census and Surveys (OPCS) version 4.5 National Intervention Classification Service (NIC) International Classification of Disease (ICD) version 10, and Healthcare Resource Groupings (HRG) version 4 Funding for the IM&T systems and associated infrastructure will be the Provider s responsibility. The Provider must undertake testing of all of the IM&T Systems proposed, including those supplied by the Provider, third party suppliers and also of any interfaces and inter-working arrangements between parties or systems, so as to guarantee compliance with all appropriate standards and to prove operational effectiveness. The Provider must put in place appropriate governance and security for the IM&T Systems to safeguard patient information The Provider must ensure that the IM&T Systems and processes comply with statutory

13 obligations for the management and operation of IM&T within the NHS, including, but not exclusively: Common law duty of confidence Data Protection Act 1998 Access to Health Records Act 1990 Freedom of Information Act 2000 Computer Misuse Act 1990 Health and Social Care Act 2008 There is a statutory obligation to protect patient identifiable data against potential breach of confidence when sharing with other countries. The Provider must meet prevailing national standards and follow appropriate NHS good practice guidelines for information governance and security, including, but not exclusively: NHS Confidentiality Code of Practice NHS Records Management Code of Practice registration under ISO/IEC and ISO or other appropriate information security standards use of the Caldicott principles and guidelines appointment of a Caldicott Guardian policies on security and confidentiality of patient information clinical governance in line with the NHS Information Governance Toolkit; and risk and incident management system To ensure the quality and safety of patient care, the IM&T Systems must also support: management of all clinical services including ordering and receipt of pathology, radiology and other diagnostic procedure results and reports prescribing and where appropriate dispensing maintenance of individual electronic Patient health records inter-communication or integration between clinical and administrative systems for use of patient demographics access to knowledge bases for healthcare, such as Map of Medicine, at the point of patient contact access to research papers, reviews, guidelines and protocols communication with Patients to support provision of quality care, including printed materials, telephone, text messaging, website, and , and access to provide printed patient information leaflets to support health promotion, provide easily understood information and help the patient to manage their condition 5. Applicable quality requirements and CQUIN goals Applicable Quality Requirements (See Schedule 4 ) 6. Location of Provider Premises The Provider s Premises are located at: 7. Individual Service User Placement Not Applicable