Add nurse-facing follow-up flow for consents with requested discussion

When a parent refuses vaccination for certain reasons (medical, personal choice, contains gelatine, other), they can request a follow-up discussion with a nurse. Here we add the nurse-side flow to resolve that request.

The nurse visits the consent record and is presented with a follow-up page showing the parent's contact details and the question "Does their original decision still stand?".

If yes (refusal confirmed): taken to a confirmation page where they can add notes and confirm the refusal. The existing consent is updated in place with follow_up_outcome: "confirmed" and follow_up_resolved_at stamped and notes amended.

If no (refusal withdrawn): taken through the full consent wizard to record a given consent on behalf of the parent (following verbal consent journey). The existing consent record (that requested follow up) is invalidated and a new "given" one created.

`:who` step omitted in follow-up flow because the parent is already  known from the original consent - there is no need to ask the nurse to select or create a contact again.

Author: murugapl

app/components/app_consent_summary_component.rb

@@ -6,6 +6,7 @@ def initialize(
     change_links: {},
     show_email_address: false,
     show_notes: false,
+    show_parent_name: false,
     show_notify_parent: false,
     show_phone_number: false,
     show_programme: false,
@@ -15,6 +16,7 @@ def initialize(
     @change_links = change_links
     @show_email_address = show_email_address
     @show_notes = show_notes
+    @show_parent_name = show_parent_name
     @show_notify_parent = show_notify_parent
     @show_phone_number = show_phone_number
     @show_programme = show_programme
@@ -27,6 +29,7 @@ def call = govuk_summary_list(rows:, actions: @change_links.present?)
 
   attr_reader :consent,
               :change_links,
+              :show_parent_name,
               :show_phone_number,
               :show_email_address,
               :show_programme,
@@ -37,12 +40,14 @@ def call = govuk_summary_list(rows:, actions: @change_links.present?)
   delegate :programme, to: :consent
   delegate :consent_response_tag,
            :govuk_summary_list,
+           :consent_parent_name,
            :consent_parent_email,
            :consent_parent_phone,
            to: :helpers
 
   def rows
     [
+      parent_name_row,
       phone_number_row,
       email_address_row,
       programme_row,
@@ -57,6 +62,12 @@ def rows
     ].compact
   end
 
+  def parent_name_row
+    if show_parent_name && (name = consent_parent_name(consent)).present?
+      { key: { text: "Parent" }, value: { text: name } }
+    end
+  end
+
   def phone_number_row
     if show_phone_number && (phone = consent_parent_phone(consent)).present?
       { key: { text: "Phone number" }, value: { text: phone } }

app/controllers/draft_consents_controller.rb

@@ -42,7 +42,10 @@ def update
 
     @draft_consent.seed_health_questions if current_step == :agree
 
-    jump_to("confirm") if @draft_consent.editing? && current_step != :confirm
+    if @draft_consent.editing? && !@draft_consent.follow_up_flow? &&
+         current_step != :confirm
+      jump_to("confirm")
+    end
 
     reload_steps
 
@@ -82,6 +85,15 @@ def handle_confirm
       PatientStatusUpdater.call(patient: @patient)
     end
 
+    if (old_consent_id = @draft_consent.follow_up_consent_id)
+      Consent.find(old_consent_id).resolve_follow_up!(
+        outcome: :withdrawn,
+        notes:
+          "#{@draft_consent.human_enum_name(:response)} in follow-up discussion.",
+        invalidate: true
+      )
+    end
+
     if @draft_consent.send_confirmation?
       @consent.notifier.send_confirmation(
         session: @session,

app/controllers/patient_sessions/consents_controller.rb

@@ -2,6 +2,13 @@
 
 class PatientSessions::ConsentsController < PatientSessions::BaseController
   before_action :set_consent, except: %i[create send_request]
+  before_action :ensure_can_follow_up,
+                only: %i[
+                  edit_follow_up
+                  update_follow_up
+                  edit_confirm_refusal
+                  update_confirm_refusal
+                ]
   before_action :ensure_can_withdraw, only: %i[edit_withdraw update_withdraw]
   before_action :ensure_can_invalidate,
                 only: %i[edit_invalidate update_invalidate]
@@ -51,6 +58,58 @@ def send_request
   def show
   end
 
+  def edit_follow_up
+    render :follow_up
+  end
+
+  def update_follow_up
+    if follow_up_params[:decision_stands].nil?
+      @consent.errors.add(:decision_stands, :blank)
+      render :follow_up, status: :unprocessable_content
+    elsif follow_up_params[:decision_stands] == "true"
+      redirect_to confirm_refusal_session_patient_programme_consent_path
+    else
+      @draft_consent = DraftConsent.new(request_session: session, current_user:)
+      @draft_consent.clear_attributes
+      @draft_consent.assign_attributes(create_params)
+      @draft_consent.follow_up_consent_id = @consent.id
+      @draft_consent.follow_up_flow = true
+      @draft_consent.new_or_existing_contact = @consent.parent_id.to_s
+      @draft_consent.route = "phone"
+
+      if @draft_consent.save
+        redirect_to draft_consent_path("agree")
+      else
+        render :follow_up, status: :unprocessable_content
+      end
+    end
+  end
+
+  def edit_confirm_refusal
+    render :confirm_refusal
+  end
+
+  def update_confirm_refusal
+    if confirm_refusal_params[:confirmed].nil?
+      @consent.errors.add(:confirmed, :blank)
+      render :confirm_refusal, status: :unprocessable_content
+    elsif confirm_refusal_params[:confirmed] == "true"
+      ActiveRecord::Base.transaction do
+        @consent.resolve_follow_up!(
+          outcome: :confirmed,
+          notes: confirm_refusal_params[:notes].to_s
+        )
+      end
+
+      redirect_to session_patient_programme_consent_path,
+                  flash: {
+                    success: "Consent from #{@consent.name} updated."
+                  }
+    else
+      redirect_to session_patient_programme_consent_path
+    end
+  end
+
   def edit_withdraw
     render :withdraw
   end
@@ -114,6 +173,10 @@ def update_patient_status
     PatientStatusUpdater.call(patient: @patient)
   end
 
+  def ensure_can_follow_up
+    redirect_to action: :show unless @consent.can_follow_up?
+  end
+
   def ensure_can_withdraw
     redirect_to action: :show unless @consent.can_withdraw?
   end
@@ -131,6 +194,14 @@ def create_params
     }
   end
 
+  def follow_up_params
+    params.permit(consent: :decision_stands)[:consent] || {}
+  end
+
+  def confirm_refusal_params
+    params.permit(consent: %i[confirmed notes])[:consent] || {}
+  end
+
   def withdraw_params
     params.expect(consent: %i[reason_for_refusal notes]).merge(
       response: "refused",

app/models/consent.rb

@@ -66,6 +66,8 @@ class Consent < ApplicationRecord
   include Notable
   include Refusable
 
+  attr_accessor :confirmed, :decision_stands
+
   audited associated_with: :patient
 
   belongs_to :patient
@@ -144,6 +146,12 @@ def can_invalidate?
     not_invalidated?
   end
 
+  def can_follow_up?
+    not_invalidated? && refusal_with_follow_up?
+  end
+
+  def follow_up_resolved? = follow_up_resolved_at.present?
+
   def responded_at
     invalidated_at || withdrawn_at || submitted_at
   end
@@ -252,6 +260,23 @@ def update_vaccination_records_no_notify!
     end
   end
 
+  def resolve_follow_up!(outcome:, notes: nil, invalidate: false)
+    ActiveRecord::Base.transaction do
+      attrs = {
+        follow_up_requested: false,
+        follow_up_outcome: outcome,
+        follow_up_resolved_at: Time.current
+      }
+
+      attrs[:invalidated_at] = Time.current if invalidate
+      attrs[:notes] = notes if notes.present?
+
+      update!(attrs)
+
+      PatientStatusUpdater.call(patient: patient)
+    end
+  end
+
   def notifier = Notifier::Consent.new(self)
 
   class ConsentFormNotRecorded < StandardError

app/models/draft_consent.rb

@@ -40,6 +40,8 @@ class DraftConsent
   attribute :triage_notes, :string
   attribute :triage_status_option, :string
   attribute :vaccine_methods, array: true, default: []
+  attribute :follow_up_consent_id, :integer
+  attribute :follow_up_flow, :boolean, default: false
   attribute :vaccine_stock_is_available, :boolean
   attribute :without_gelatine, :boolean
 
@@ -52,7 +54,7 @@ def initialize(current_user:, **attributes)
 
   def wizard_steps
     [
-      :who,
+      (:who unless follow_up_flow?),
       (:parent_details unless via_self_consent?),
       (:route unless via_self_consent?),
       (:mmrv_vaccine_availability if eligible_for_mmrv?),
@@ -341,6 +343,8 @@ def write_to!(consent, triage_form:)
     end
   end
 
+  def follow_up_flow? = follow_up_flow == true
+
   def via_self_consent? = route == "self_consent"
 
   def send_confirmation? = notify_parent_on_refusal != false

app/views/patient_sessions/consents/confirm_refusal.html.erb

@@ -0,0 +1,28 @@
+<% content_for :before_main do %>
+  <%= govuk_back_link(href: follow_up_session_patient_programme_consent_path) %>
+<% end %>
+
+<%= form_with model: @consent, url: confirm_refusal_session_patient_programme_consent_path, method: :post do |f| %>
+  <%= f.mavis_error_summary %>
+
+  <% page_title = "Update consent response" %>
+  <%= h1 page_title: do %>
+    <span class="nhsuk-caption-l">
+      Consent response from <%= @consent.name %>
+    </span>
+    <%= page_title %>
+  <% end %>
+
+  <%= f.govuk_text_area :notes, label: { text: "Notes" } %>
+
+  <%= f.govuk_radio_buttons_fieldset :confirmed,
+                                     legend: { text: "Confirm consent refusal?" } do %>
+    <%= f.govuk_radio_button :confirmed, "true",
+                             label: { text: "Yes" },
+                             link_errors: true %>
+    <%= f.govuk_radio_button :confirmed, "false",
+                             label: { text: "No" } %>
+  <% end %>
+
+  <%= f.govuk_submit "Save changes" %>
+<% end %>

app/views/patient_sessions/consents/follow_up.html.erb

@@ -0,0 +1,31 @@
+<% content_for :before_main do %>
+  <%= govuk_back_link(href: session_patient_programme_consent_path) %>
+<% end %>
+
+<%= form_with model: @consent, url: follow_up_session_patient_programme_consent_path, method: :post do |f| %>
+  <%= f.mavis_error_summary %>
+
+  <% page_title = "Follow up refusal" %>
+  <%= h1 page_title: do %>
+    <span class="nhsuk-caption-l">
+      Consent response from <%= @consent.name %>
+    </span>
+    <%= page_title %>
+  <% end %>
+
+  <div class="nhsuk-inset-text">
+    <span class="nhsuk-u-visually-hidden">Information: </span>
+    <%= render AppConsentSummaryComponent.new(@consent, show_parent_name: true, show_email_address: true, show_phone_number: true, show_programme: true, show_notes: true) %>
+  </div>
+
+  <%= f.govuk_radio_buttons_fieldset :decision_stands,
+                                     legend: { text: "Does their original decision still stand?" } do %>
+    <%= f.govuk_radio_button :decision_stands, "true",
+                             label: { text: "Yes" },
+                             link_errors: true %>
+    <%= f.govuk_radio_button :decision_stands, "false",
+                             label: { text: "No" } %>
+  <% end %>
+
+  <%= f.govuk_submit "Continue" %>
+<% end %>

app/views/patient_sessions/consents/show.html.erb

@@ -5,6 +5,13 @@
 <%= h1 "Consent response from #{@consent.name}" %>
 
 <%= render AppActionListComponent.new do |action_list| %>
+  <% if @consent.can_follow_up? %>
+    <% action_list.with_item(
+         text: "Follow up",
+         href: follow_up_session_patient_programme_consent_path,
+       ) %>
+  <% end %>
+
   <% if @consent.can_withdraw? %>
     <% action_list.with_item(
          text: "Withdraw consent",

config/locales/en.yml

@@ -447,6 +447,10 @@ en:
               blank: Choose a file
         consent:
           attributes:
+            confirmed:
+              blank: Select yes or no
+            decision_stands:
+              blank: Select yes or no
             notes:
               blank: Enter notes
               too_long: Enter notes that are less than %{count} characters long

config/routes.rb

@@ -315,6 +315,12 @@
           post "send-request", on: :collection, action: :send_request
 
           member do
+            get "follow-up", action: :edit_follow_up
+            post "follow-up", action: :update_follow_up
+
+            get "confirm-refusal", action: :edit_confirm_refusal
+            post "confirm-refusal", action: :update_confirm_refusal
+
             get "withdraw", action: :edit_withdraw
             post "withdraw", action: :update_withdraw