1. Service selection guidance What is it? How and when is it used? How is it developed? How does it appear to users? Primary and secondary care responsibilities Experience to date

2. What is it?  Service Selection Guidance is a decision tree to help clinicians identify appropriate services for a particular patient’s needs  Clinicians should define the questions, the sequence in which they are asked, the answers and outcomes

3. How and when is it used?

4. Establish assumptions including clinic types Develop and agree decision trees Review and sign off across LHC Sign off Engagement Development Enter trees into Service Builder tool Primary and secondary care clinicians, service or clinic managers, commissioners How is it developed? Refine and maintain in Choose and Book Maintenance

5. Decision tree for General Surgery Q:What does patient present with? General Surgery Urgent General Surgery Urgent A: Lump in groin Q:Is lump in groin tender? A: Yes A: No General Surgery Urgent General Surgery Urgent Q:Is lump pulsatile? A: Yes A: No Q:Is lump reducable? A: Yes A: No General Surgery Routine General Surgery Routine General Surgery Urgent General Surgery Urgent A: Inguinal hernia

6. Q:What does patient present with? General Surgery Urgent General Surgery Urgent A: Lump in groin Q:Is lump in groin tender? A: Yes A: No General Surgery Urgent General Surgery Urgent Q:Is lump pulsatile? A: Yes A: No Q:Is lump reducable? A: Yes A: No General Surgery Routine General Surgery Routine General Surgery Urgent General Surgery Urgent A: Inguinal hernia

7. Defining rules, questions and decision points

32. Primary and secondary care responsibilities  PCTs to own the guidance development  Clinical leads to help develop the guidance  Primary and secondary care clinicians, Service or Clinic managers to provide input to development process  Consultants and commissioners to agree outcomes

33. Experience to date  Care pathways and Medic to Medic’s Map of Medicine ® can be useful starting points  You don’t necessarily need it for all specialties  It needs to be as concise as possible  It’s worth the effort  The Choose and Book website can be a useful source of reference material

34. Service selection guidance