Explore team April update

Edited formatting, added images

Author: veroje

app/images/explore-team/2025/04/finding-the-right-solution-for-sharing-breast-results-with-GPs/perforated-paper-in-printer.jpg

@@ -195,7 +195,7 @@ There is still some work for us to do before we can scope the route to delivery:
 
 * results printing in BSOs: what happens in those BSOs that print in-house and those that use ‘other’ types of outsourcing?
 * what are the intended and unintended consequences of a solution (eg for printing service providers) - we are collaborating with the transition team on this
-* what are the timeline, cost, complexity of each option - we are collaborating with the transition team and the [manage team](/manage-breast-screening/) on a single survey to BSOs; colleagues mentioned Lucy Jenkins' analysis that we should follow
+* what are the timeline, cost, complexity of each option - we are collaborating with the transition team and the [manage team](/manage-breast-screening/) on a single survey to BSOs 
 * who and how will take this work forward, if, as we are learning, there is a benefit to delivering it?
 
 ## Next steps

app/posts/explore-team/2025/03/2025-03-12-what-we-learned-about-sharing-breast-and-bowel-results-with-gps.md

@@ -16,104 +16,150 @@ We are learning how we can improve the sharing of screening results with GPs (se
 
 Having looked at breast and bowel cancer screening services in some detail, we decided to narrow our focus to:
 
-- breast screening over bowel cancer screening 
-- normal and ‘did not attend’ (DNA) results over abnormal or other result types
+* breast screening over bowel cancer screening 
+* normal and ‘did not attend’ (DNA) results over abnormal or other result types
 
-We wrote about this in more detail in our previous update on [what we were learning](https://nhsdigitalcorporate.enterprise.slack.com/docs/T0FRZQSMB/F08PGETDG05?focus_section_id=temp:C:RVAa8d5cc0e0c3f43e78c216019d). 
+We wrote about this in more detail in our previous update on [what we were learning](https://design-history.prevention-services.nhs.uk/explore-team/2025/01/sharing-screening-results-with-gps/). 
 
 ![A 'breast care unit' sign on a sunny day](humberside-bso.jpeg "We visited the breast care unit at Humberside to learn more about their work")
 
 ## Why breast screening over bowel cancer screening?
 
-- 99% of all normal results in bowel are already sent electronically
-- bowel cancer screening results use the ‘pathology’ route and are working well for GPs
+* 99% of all normal results in bowel are already sent electronically
+* bowel cancer screening results use the ‘pathology’ route and are working well for GPs
+
+One GP practice staff member told us: 
+
+> “I’d like to see something like bowel coding.” 
+
+They showed us how easy it was to apply rules to bowel screening results and auto-file them: 
 
-One GP practice staff member told us:  
-> “I’d like to see something like bowel coding,”  
-and showed us how easy it was to apply rules to bowel screening results and auto-file them:  
 > “You tick a box that correlates to the pathology screen, apply a really quick rule and it will autofile in 2 minutes.”
 
+![Special perforated paper in a printer](perforated-paper-in-printer.jpg "Special perforated paper used for breast screening GP reports, kindly sent to us by one BSO")
+
 ## Being creative and pragmatic
 
-While bowel pathology route is working well, breast screening results cannot just go the same route as bowel. [The ‘pathology’ route used by bowel](https://design-history.prevention-services.nhs.uk/explore-team/2025/03/what-we-learned-about-sharing-breast-and-bowel-results-with-gps/#how-results-are-shared%3A-bowel-screening) uses old technology that is marked for deprecation and is in the process of being upgraded. 
+While bowel pathology route is working well, breast screening results cannot just follow the same route as bowel. [The ‘pathology’ route used by bowel](https://design-history.prevention-services.nhs.uk/explore-team/2025/03/what-we-learned-about-sharing-breast-and-bowel-results-with-gps/#how-results-are-shared%3A-bowel-screening) uses old technology that is marked for deprecation and is in the process of being upgraded. 
 
 A technical architect colleague told us:  
-> “You could try to shoehorn it into an EDIFACT pathology message. Even if you can do it, you shouldn't.”
 
-A designer colleague working in vaccinations told us:  
-> “Be tactical — find an opening. What we have doesn’t match any diagram.” 
+> “You could try to shoehorn it into an [EDIFACT](https://digital.nhs.uk/developer/api-catalogue/pathology-messaging-edifact) pathology message. Even if you can do it, you shouldn't.”
+
+A designer colleague working in vaccinations told us: 
+
+> “Be tactical, find an opening. What we have doesn’t match any diagram.” 
 
 So, while we used some high-level solutions to encourage ideas, it will be up to the alpha team to decide, creatively and pragmatically, on the short-term solution. They would need to weigh it up against longer-term and adjacent solutions. 
 
 ## The 3 Alpha team tracks
 
 Because of this complex context, we suggest that the alpha team should work across 3 tracks:
 
-- experiment track: can the team find a usable, viable and feasible solution?
-- approvals track: can the team get all the right approvals?
-- collaboration track: can the team coordinate with other teams whose work affects this work and vice versa?
+* experiment track: can the team find a usable, viable and feasible solution?
+* approvals track: can the team get all the right approvals?
+* collaboration track: can the team coordinate with other teams whose work affects this work and vice versa?
 
 ## Alpha team problem
 
 We summarised the problem:
 
-> 3 million breast screening results are sent annually to GP surgeries in paper and PDF formats. This leads to inaccurate screening data, high processing costs and worse patient care. 
+3 million breast screening results are sent annually to GP surgeries in paper and PDF formats. This leads to inaccurate screening data, high processing costs and worse patient care. 
 
 Some trusts have started implementing their own solutions, but what they can do is limited — data from the 75 instances of the legacy NBSS is not readily available to them. 
 
-There is variation in how results are generated in each BSO. GP and patient results are not necessarily processed the same way, but both need to come from the same data source to ensure integrity. 
+There is variation in how results are generated in each BSO (breast screening office). GP and patient results are not necessarily processed the same way, but both need to come from the same data source to ensure integrity. 
 
 ## Alpha team brief
 
-> Find the right combination of technologies to make normal and DNA breast screening results available to patients and GPs in a way that allows them to be added to patient records efficiently and accurately. 
+Find the right combination of technologies to make normal and DNA breast screening results available to patients and GPs in a way that allows them to be added to patient records efficiently and accurately. 
 
 ## Assumptions to invalidate
 
 We say ‘invalidate’ because the goal is to experiment, test, learn and iterate to reduce risk. We have blind spots and the alpha team’s job is to explore them and to find what works. 
 
-| Assumptions | Evidence | Risk type | User or actor | Confidence |
-|------------|----------|-----------|----------------|-------------|
-| GPs, BSOs and NHSE need breast screening results to be automated | Qualitative feedback from GPs, BSOs and NHSE | value | GP, BSO, NHSE | high |
-| EMIS and TPP will be able to implement a solution within a reasonable timeframe | Total time to implement by GP IT is 18-24 months (6 months roadmap; 6-18 delivery) | feasibility | EMIS, TPP, DSIC | medium |
-| We can obtain patient and GP results within a reasonable timeframe | BS Select feedback that it is already possible; Screening working group set up | feasibility | DPSP | medium |
-| We can tag results with SNOMED CT codes within a reasonable timeframe | Several colleagues have done work to create breast screening SNOMED codes | feasibility | DPSP | medium |
-| All BSOs (including those using Synertec, Civica, in-house, ‘other’) will be able to transition to the new result process easily for patients (SMSTA) and GPs (SIL) | There are 75 instances of NBSS running locally in 77 BSOs, changes need to be implemented one by one. BSOs will be impacted differently depending on who handles their results (Synertec, Civica, in-house, ‘other’) | viability | BSO | low |
-| It is cheaper and quicker to build this short-medium term solution than to build a fundamental solution | Replacing NBSS with a new system may mean that BSOs are able to access results and find their own solution | viability | DPSP, BSOs | low |
-| Breast screening result data would be extracted into a central screening repository before being shared with GPs | Team MAYS is implementing a digital screening strategy that enables the extraction and centralisation of results data | feasibility | MAYs | medium |
+### GPs, BSOs and NHSE need breast screening results to be automated
+
+* evidence: qualitative feedback from GPs, BSOs and NHSE
+* risk type: value
+* user or actor: GP, BSO, NHSE
+* confidence: high
+
+### GP IT providers will be able to implement a solution within a reasonable timeframe 
+
+* evidence: total time to implement by GP IT is 18-24 months (6 months roadmap; 6-18 delivery)
+* risk type: feasibility
+* user or actor: EMIS, TPP, DSIC
+* confidence: medium
+
+### We can obtain patient and GP results within a reasonable timeframe
+
+* evidence: BS Select feedback that it is already possible; Screening working group set up
+* risk type: feasibility
+* user or actor: DPSP
+* confidence: medium
+
+### We can tag results with SNOMED CT codes within a reasonable timeframe
+
+* evidence: several colleagues have done work to create breast screening SNOMED codes
+* risk type: feasibility
+* user or actor: DPSP
+* confidence: medium
+
+### All BSOs will be able to transition to the new result process easily for patients (SMSTA) and GPs (SIL)
+
+* evidence: there are 75 instances of NBSS running locally in 77 BSOs, changes need to be implemented one by one. BSOs will be impacted differently depending on who handles their results (Synertec, Civica, in-house, ‘other’)
+* risk type: viability
+* user or actor: BSO
+* confidence: low
+
+### It is cheaper and quicker to build this short-medium term solution than to build a fundamental solution
+
+* evidence: replacing NBSS with a new system may mean that BSOs are able to access results and find their own solution
+* risk type: viability
+* user or actor: DPSP, BSOs
+* confidence: low
+
+### Breast screening result data would be extracted into a central screening repository before being shared with GPs
+
+* evidence: team MAYS is implementing a digital screening strategy that enables the extraction and centralisation of results data
+* risk type: feasibility
+* user or actor: MAYS
+* confidence: medium
+
 
 ## Hypothesis 
 
-> We believe making normal and DNA breast screening results available to GPs in a structured format  
-> will result in cheaper, faster and more accurate result processing, as well as more accurate uptake data  
-> for BSOs, GPs, patients and the breast screening programme.  
->
-> We will know this is true when we receive quantitative and qualitative feedback from GPs, BSOs and patients that the new process is working better for them.
+**We believe** making normal and DNA breast screening results available to GPs in a structured format
+
+**will result in** cheaper, faster and more accurate result processing, as well as more accurate uptake data  
+**for** BSOs, GPs, patients and the breast screening programme.  
+
+**We will know this is true** when we receive quantitative and qualitative feedback from GPs, BSOs and patients that the new process is working better for them.
 
 ## The emergent user needs
 
-As a GP administrator 
-I need an easy way to process and file medical reports  
-so that I can focus on providing care to patients
+There is a wide range of job roles within GP practices and BSOs. We are deliberately using broad user types ('GP administrator' and 'BSO') until we learn more. 
+
+### As a GP administrator
+**I need** an easy way to process and file medical reports  
+**so that** I can focus on providing care to patients
 
-As a GP administrator
-I need to identify patients who miss screening appointments  
-so that I can understand their reasons and support them to attend
+**I need** to identify patients who miss screening appointments  
+**so that** I can understand their reasons and support them to attend
 
-As a BSO
-I need breast screening results to be reliably stored
-so that GPs and patients can access them when needed, rather than having to request this information from us
+### As a BSO
+**I need** breast screening results to be reliably stored
+**so that** GPs and patients can access them when needed, rather than having to request this information from us
 
-As a BSO
-I need an easy, cost-effective and reliable way to share screening results with patients  
-so that they feel reassured and know what, if any, action to take
+**I need** an easy, cost-effective and reliable way to share screening results with patients  
+**so that** they feel reassured and know what, if any, action to take
 
-As a BSO
-I need an easy, cost-effective and reliable way to share screening results with GPs  
-so that the patient screening record is accurate for future screening
+**I need** an easy, cost-effective and reliable way to share screening results with GPs  
+**so that** the patient screening record is accurate for future screening
 
-As a BSO
-I need GPs to help identify people who haven’t attended screening  
-so that GPs can encourage them to attend
+**I need GPs** to help identify people who haven’t attended screening  
+**so that** GPs can encourage them to attend
 
 ## Next steps