Book an appointment

Book an appointment for a patient at an organisation

Use case

Important: The Appointment Management capability pack is aimed at administration of a patient’s appointments. As a result of information governance (IG) requirements the book appointment capability has been restricted to future appointments. See Design decisions.

The typical flow to book an appointment is:

Search by NHS Number for, or otherwise obtain, a Patient resource.
Search for available Slot resources by date range.
Create an Appointment for the chosen Slot and Patient resources.

Refer to Consumer sessions illustrated for how this API use case could be used in the context of a typical consumer appointment management session.

Security

GP Connect utilises TLS Mutual Authentication for system level authorization
GP Connect utilises a JSON Web Tokens (JWT) to transmit clinical audit and provenance details

Prerequisites

Consumer

The consumer system:

SHALL have previously resolved the organisation’s FHIR® endpoint base URL through the Spine Directory Service
SHALL have previously traced the patient’s NHS Number using the Personal Demographics Service or an equivalent service.
SHALL have previously obtained the details for one or more free slots that are to be booked, using Search for free slots
SHALL have previously performed a Find a patient request to obtain the logical identifier for the patient on the organisation’s FHIR server.

API usage

The consumer system SHALL only use the book appointment capability to book future appointments, where the appointment start dateTime is after the current date and time. If the appointment start date is in the past the provider SHALL return an error.

Adherence is expected to local business rules, agreements and policies defining good practice in GP Connect-enabled cross-organisational appointment booking. This will discourage for example the over-booking and subsequent cancellation of Slots.

Booking multiple adjacent slots

To book more than one slot in the same Book Appointment message, a consumer needs to be able to identify which adjacent slots may be booked together. This is determined by the following rules:

Two slots (Slot A and Slot B) are adjacent when the start time of Slot B equals the end time of Slot A
The adjacent slots SHALL reference the same Schedule resource
The adjacent slots SHALL both have the same deliveryChannel value
The adjacent slots SHALL both have the same serviceType value
If the slots do not conform to one or more of the rules above, they SHALL NOT be accepted as part of the same appointment booking

Request operation

FHIR relative request

POST /Appointment

FHIR absolute request

POST https://[proxy_server]/https://[provider_server]/[fhir_base]/Appointment

Request headers

Consumers SHALL include the following additional HTTP request headers:

Header	Value
`Ssp-TraceID`	Consumer’s TraceID (i.e. GUID/UUID)
`Ssp-From`	Consumer’s ASID
`Ssp-To`	Provider’s ASID
`Ssp-InteractionID`	`urn:nhs:names:services:gpconnect:fhir:rest:create:appointment-1`

Payload request body

The request payload is a profiled version of the standard FHIR Appointment resource. See the FHIR resources page for more detail.

Consumer systems:

SHALL send an Appointment resource that conforms to the GPConnect-Appointment-1 profile.
SHALL include the URI of the GPConnect-Appointment-1 profile StructureDefinition in the Appointment.meta.profile element of the appointment resource.

The following data elements are mandatory (that is, data MUST be present):

a patient participant of the appointment.
a location participant of the appointment, representing the physical location where the appointment is to take place (see Design decisions page).
an actor reference in any supplied participant.
the start and end of the appointment.
- where multiple slots are being booked, the start SHALL be the start time of the earlier slot, and the end shall be the end time of the latest slot
the status identifying the appointment as “booked”.
the slot details of one or more free slots to be booked.
- where multiple slots are being booked, they SHALL meet the conditions required to be booked together - see Booking multiple adjacent slots
the bookingOrganisation extension referencing an contained Organization resource within the appointment resource.
- the contained organization resource SHALL represent the organization booking the appointment.
- the contained organization resource SHALL conform to CareConnect-GPC-Organization-1 profile.
- the contained organization resource SHALL contain an identifier with the organisation’s ODS code.
- the contained organization resource SHALL contain at least name and telecom details.
- the contained organization resource SHALL include the type element with a value matching the organization type sent as a searchFilter with the Search for free slots request. If organization type was not passed to the searchFilter then type SHALL not be populated.
the created element SHALL be populated with the date and time the appointment was created.
description containing a brief description of the appointment.
- Consumers SHALL impose a character limit of 100 characters for this element.
- This element SHALL only contain limited information to support the appointment and SHALL NOT be used for “transfer of care” clinical information.

The following data elements SHOULD be included when available:

a practitioner participant of the appointment.

The following data elements MAY be included:

comment containing ‘patient specific notes’ and any additional comments relating to the appointment.
- Consumers SHALL impose a character limit of 500 characters for this element.
- This element SHALL only contain limited information to support the appointment and SHALL NOT be used for “transfer of care” clinical information.

The following data elements MUST NOT be included:

reason
specialty

Note: The provider system receiving the bookingOrganization details SHALL store, return and display these details as required by the Must-Support flag.

Provider handling of description and comment

When receiving description and comment fields in the provider system:

Providers systems SHALL store information received in description and comment fields, supporting the character limit lengths shown above
Providers systems SHALL NOT truncate information received in description or comment fields
Providers SHALL return description and comment fields to the consumer in the response payload, as stored
Where a consumer sends information longer than character limits supported, an error SHALL be returned to the consumer
Where there are not two suitable appointment text fields in a provider system, providers MAY concatenate description and comment (with suitable delimiters) in order to store in a single field, such that data is not lost

Example request body

On the wire, a JSON serialised request would look something like the following:

{
  "resourceType": "Appointment",
  "meta": {
    "profile": [
      "https://fhir.nhs.uk/STU3/StructureDefinition/GPConnect-Appointment-1"
    ]
  },
  "contained": [
    {
      "resourceType": "Organization",
      "id": "1",
      "meta": {
        "profile": [
          "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
        ]
      },
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "A00001"
        }
      ],
      "type": [
        {
          "coding": [
            {
              "system": "https://fhir.nhs.uk/STU3/CodeSystem/GPConnect-OrganisationType-1",
              "code": "gp-practice"
            }
          ]
        }
      ],
      "name": "Test Organization Name",
      "telecom": [
        {
          "system": "phone",
          "value": "0300 303 5678"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-BookingOrganisation-1",
      "valueReference": {
        "reference": "#1"
      }
    }
  ],
  "status": "booked",
  "description": "Free text description.",
  "start": "2017-05-30T10:00:00+01:00",
  "end": "2017-05-30T10:25:00+01:00",
  "slot": [
    {
      "reference": "Slot/1"
    }
  ],
  "created": "2017-05-25T13:48:41+01:00",
  "comment": "Free text comment.",
  "participant": [
    {
      "actor": {
        "reference": "Patient/1"
      },
      "status": "accepted"
    },
    {
      "actor": {
        "reference": "Location/32"
      },
      "status": "accepted"
    }
  ]
}

Error handling

Provider systems:

SHALL return an HTTP status “409” with an error message “DUPLICATE_REJECTED” when an appointment cannot be booked because the referenced slots within the appointment resource no longer have the status free, such as when the slot has been used to book a different appointment between the “search for free slots” request and the “book appointment” request.
SHALL return an error if reason or specialty is included in the appointment resource sent by the consumer.
SHALL return a GPConnect-OperationOutcome-1 resource that provides additional detail when one or more request fields are corrupt or a specific business rule/constraint is breached.

For example:

the submitted start and end date range does not match that of the requested slot(s)
one or more of the requested Slot resources does not exist or already has a status of busy
a business rule imposed by Slot Availability Management is breached, e.g. an organisational slot limit
multiple slots were requested for booking but do not meet the criteria for booking multiple adjacent slots
the description or comment fields contain more characters than can be stored in the provider system

Refer to Development - FHIR API guidance - error handling for details of error codes.

Important: Provider systems MAY implement business rules to protect the responsible use of the booking API, in line with current business rules already in place, to prevent misuse of appointment booking outside of the GP Connect API implementation.

Request response

Response headers

Provider systems are not expected to add any specific headers beyond that described in the HTTP and FHIR® standards.

Payload response body

Provider systems:

SHALL return a 201 Created HTTP status code on successful execution of the operation.
SHALL return a Location header as described in FHIR API guidance.
SHALL return an Appointment resource that conform to the GPConnect-Appointment-1 profile.
SHALL include the URI of the GPConnect-Appointment-1 profile StructureDefinition in the Appointment.meta.profile element of the returned appointment resource.
SHALL include the versionId of the current version of each appointment resource.
SHALL populate Appointment.serviceType.text with the practice defined slot type description, and where available Appointment.serviceCategory.text with a practice defined schedule type description (may be called session name or rota type).
SHALL meet General FHIR resource population requirements populating all fields where data is available, excluding those listed below
SHALL NOT populate the following fields:
- reason
- specialty

{
  "resourceType": "Appointment",
  "id": "9",
  "meta": {
    "versionId": "636068818095315079",
    "profile": [
      "https://fhir.nhs.uk/STU3/StructureDefinition/GPConnect-Appointment-1"
    ]
  },
  "contained": [
    {
      "resourceType": "Organization",
      "id": "1",
      "meta": {
        "profile": [
          "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
        ]
      },
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "A00001"
        }
      ],
      "name": "Test Organization Name",
      "telecom": [
        {
          "system": "phone",
          "value": "0300 303 5678"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-BookingOrganisation-1",
      "valueReference": {
        "reference": "#1"
      }
    },
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-PractitionerRole-1",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://fhir.nhs.uk/STU3/CodeSystem/CareConnect-SDSJobRoleName-1",
            "code": "R0260",
            "display": "General Medical Practitioner"
          }
        ]
      }
    },
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-DeliveryChannel-2",
      "valueCode": "In-person"
    }
  ],
  "status": "booked",
  "serviceCategory": {
    "text": "General GP Appointments"
  },
  "serviceType": [
    {
      "text": "General GP Appointment"
    }
  ],
  "description": "Free text description.",
  "start": "2017-05-30T10:00:00+01:00",
  "end": "2017-05-30T10:25:00+01:00",
  "slot": [
    {
      "reference": "Slot/1"
    }
  ],
  "created": "2017-05-25T13:48:41+01:00",
  "comment": "Free text comment.",
  "participant": [
    {
      "actor": {
        "reference": "Patient/1"
      },
      "status": "accepted"
    },
    {
      "actor": {
        "reference": "Location/32"
      },
      "status": "accepted"
    }
  ]
}