Amend an appointment for a patient at an organisation

Use case

This API is used to amend the description or comment fields of a patient’s future appointment, obtained via either the Retrieve a patient’s appointments, or Read an appointment APIs.

Any future appointment irrespective of booking organisation, and irrespective of whether the appointment was booked via the GP Connect API, can be amended by a consuming organisation participating with the appointment hosting organisation in a GP Connect deployment.

The typical flow to amend an appointment is:

1. Search by NHS number for, or otherwise obtain, a Patient resource.
2. Search for Appointment resources for the Patient resource.
3. Choose an Appointment resource and update description and/or comment fields.

Amending a cancelled appointment is NOT supported.

Important: The Appointment Management capability pack is aimed at administration of a patient’s appointments. As a result of information governance (IG) requirements, the amend appointments capability has been restricted to future appointments. More details are available on the Design decisions page.

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 found the appointment ID using Retrieve a patient’s appointments

API usage

The consumer system SHALL only use the amend appointment capability to amend:

• description or comment fields. Providers SHALL return an error when any other field is amended.
• future appointments where appointment start date/time is after the current date/time. If the appointment start date/time is in the past the provider SHALL return an error.
• appointments that have not been cancelled. Providers SHALL return an error where an amendment to a cancelled appointment is received.

Request operation

FHIR relative request

PUT /Appointment/[id]

FHIR absolute request

PUT https://[proxy_server]/https://[provider_server]/[fhir_base]/Appointment/[id]

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:update:appointment-1
If-Match	The Appointment’s current ETag, e.g. W/"23"

Payload request body

The request payload is a profiled version of the standard FHIR Appointment resource. See 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.
• SHALL NOT amend an appointment with a status of cancelled

Only the following data elements can be modified when performing an appointment amendment:

• 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.
• 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.

Important: It is recommended that Consumers read the Appointment they wish to amend (via Read an appointment or Retrieve a patient’s appointments), then update the fields allowed below in place. Attempting to recreate the Appointment resource from local transformed data formats/structures is not advised, and may result in the provider system rejecting the amendment due to an unintended change or missing field.

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",
  "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"
        }
      ],
      "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 updated.",
  "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

The provider system:

• 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.
• SHALL return an error where:
  • any appointment details other than the appointment comment or description are amended. The appointment resource should be considered invalid and the provider system should return a 422 error with error code INVALID_RESOURCE.
  • the appointment being amended is in the past (the appointment start dateTime is before the current date and time).
  • the appointment has been cancelled. Provider systems should return a 422 error with error code INVALID_RESOURCE.
  • the version identifier in the If-Match header does not match the Appointment’s current version identifier. See Managing resource contention.
  • 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.

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 200 OK HTTP status code on successful execution of the operation.
• SHALL return 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 returned appointment resource.

• SHALL include the versionId of the current version of the appointment resource.

• SHALL populate serviceType.text with the practice defined slot type description, and where available 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": "6360688180953112345",
    "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"
      }
    },
    {
      "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 updated.",
  "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"
    }
  ]
}