By Tony Collins
Choose and Book, which is one of the limited successes of the NHS National Programme for IT, may be “withering on the vine” says Pulse.
It reports that the Department of Health is investigating a fall in the proportion of GP referrals made through Choose and Book. Several PCTs have described Choose and Book as “failing”.
Pulse says that the Government’s notional target is for 90% of GP referrals to be made through Choose and Book, but the latest figures indicate usage has fallen from a high two years ago of 57%, to around 50% in January 2012
Initiated in 2004, Choose and Book is now in use in every PCT and provider organisation across the NHS in England, including many independent sector organisations that deliver services to the NHS under a standard, national contract.
Choose and Book provides patients with the offer of choice of hospital and clinic and a booked appointment.
The Department of Health told Pulse that there have been falls in use in some areas but it was committed to ‘embed Choose and Book into daily clinical practice’.
Choose and Book was classified as ‘failing and worsening’ in February board papers from Bristol, North Somerset and South Gloucestershire PCTs, says Pulse.
DH press release in 2003
A Department of Health press release on the award of a contract for an electronic booking system to Atos said in October 2003 said
“By the end of 2005, every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs.”
Pulse suggests the drop in interest may be because GP practices are no longer paid to use Choose and Book.
Through “local enhanced service” payments to GPs, primary care trusts have given family doctors a strong reason to use Choose and Book. The payments to GPs have ranged from about 50p to about £4 for every patient booked through Choose and Book. That funding is drying up.
A locum GP who commented on Pulse’s website suggests that Choose and Book will fall into disuse without financial incentives: “I couldn’t fit it [a Choose and Book appointment] into a ten minute consult what with QOF [quality and outcomes framework, part of the GP contract] the patient’s list etc – had to do referrals at the end of the day, so never used it.”
The failure of Choose and Book to reach anything like the original target of 100% use throughout the NHS shows the fallacy of paying people, in this case GPs, to use national IT systems.
New IT should be so needed that its use doesn’t depend on special payments to the end-users. Choose and Book was trumpeted by some major suppliers as a simple and obvious solution – rather like an airline reservation system; and after years of bedding down the technology works. But GPs cannot be forced to use it.
The Department of Health had considered the NPfIT to be the centre of universe, and that doctors would want to use it for the common good.
The fact is that GPs care only about their patients – which is as it should be – and if they consider the system detracts from the time spent with their patients the common good becomes an abstract, indeed meaningless, concept.
Choose and Book was always a good idea, a fun thing to work on. But does a 50% take-up after nine years justify the hundreds of millions spent on it? The Department of Health is hopeful the scheme will eventually succeed. But then the DH has always been confident the NPfIT would succeed.
DH to investigate fall in the use of Choose and Book – Pulse.
There are also secondary service providers who have opted out of C&B simply by redefining the service they provide from outpatient to community. Same service same quality of care but no C&B. I suspect that if one really looked at the number of first appointments which took place nationally and then compared that to the number done via C&B there would be far less than 50%. Begs several questions doesn’t it?
I’m a GP.
From my – and probably my patients’ – point of view, there are a number of problems (quite apart from the clunky interface) with the implementation of C&B.
-time: what proportion of a 10 minute consultation ought to be devoted to discussing need for referral, referral options and booking an appointment then and there?
– as a patient, are you in a position to decide on a date and time on the spot? Most people have, as it were, outside commitments made by other family members or employers?
– how much information does/should a GP have about the possible providers – and what information is relevant?
– what are the criteria important to the *individual patient*? proximity? success rate? parking? something else?
– what slots are available? is there an individual consultant option? *how usual is it for the appointment to be booked – and then transfered to a more hosptaly desirable date/time without reference to patient demsand/request?
Buisness case and workload implicaions remain obscure – and this sort of thing does increase workload and resource competition!