I believe that much of GPs' mistrust of the Choose and Book national booking system stems from a basic problem: they do not realise that it is so simple to use.
As Choose and Book medical director for primary care, I have found that GPs' most common reaction when they see the system demonstrated is to say: 'Is that all it is?' They are genuinely surprised that using the system is so straightforward.
Paper versus computer
Comparing the old paper-based referrals system to Choose and Book is instructive. With the former, the GP and patient decide during the consultation that a referral to a specialist is necessary.
The GP dictates a referral letter to a secretary, advising which consultant and hospital the letter should be sent to. The practice then posts the letter. If the receiving clinician accepts the referral, a booking is made and the patient is sent a letter with the date and time.
The hospital department concerned has no idea if the patient will be able to attend on the given date. If the booking is unsuitable, it is up to the patient to re-arrange it by phoning the hospital. Unsurprisingly, hospital outpatient 'did not attend' rates are estimated at 12-16 per cent.
The government's choice agenda presents further problems for paper-based referrals. This means we will have to consider more options than previously over time and location.
There are tools to help GPs do this manually, but it is more efficient to use Choose and Book.
When I refer a patient to specialist care, my first step is to put the patient's details into the Choose and Book system. These can be transferred directly from the practice system if this is integrated with Choose and Book. If not, the alternative is to use the Choose and Book web-based 'referrer'. This locates the patient in the Choose and Book personal demographic service (PDS).
I then select the appropriate specialty and clinic from the list and ask the system to search for services. Choose and Book will return a list of services from which the patient can choose.
At this point, I talk to the patient about the choices. I can create an appointment request, print it off with the choices and give it to them.
Once the patient has decided which clinic they want to attend, they can make an appointment by phone or, in many cases, online.
If they choose immediately, I can make an appointment for them and use the Choose and Book system to generate a 'unique booking reference number' (UBRN).
The system also automatically generates the patient's password. This, for security purposes, is not printed with the appointment request.
Armed with the appointment request, password and a print-out of the booking details, the patient can change their appointment later if they need to. If I do not give a patient their password, I can ask them to pick it up from reception before leaving the surgery.
If I do not make the appointment and give the patient their UBRN and password, the process takes a minute or two.
With Choose and Book, many appointments can be made online by the GP or by other practice staff. These are known as 'directly bookable services' (DBS) and the patient can select an appointment from the available slots displayed on the screen.
This is only possible when the patient administration system (PAS) of the selected hospital is compliant with Choose and Book.
In time, all hospitals' systems will be compliant, but at present some referrals to 'indirectly bookable services' (IBS) are online.
With these services, patients phone their chosen hospital to book an appointment. Booking personally means they can talk to family and colleagues before deciding when and where they want to be seen.
In the case of the elderly or people with learning difficulties, a carer can make the booking on the patient's behalf or practice staff might be able to do this for them.
I find that most patients are happy to make IBS appointments themselves.
The Choose and Book software alerts me as soon as they make the booking.
I often find that patients book before the surgery session they attended has finished.
There are more options for patients choosing to attend a directly booked clinic if neither the GP nor a practice staff member makes the appointment for them.
In most cases (apart from small number of PCTs), the patient can ring the Choose and Book appointments line. As well as making the booking, the appointments line can give the patient non-clinical information such as waiting times and transport so that they can make an informed choice.
Patients can also find non-clinical information at www.nhs.uk.
It is important to note that the appointments line is a call centre service that does not automatically give information or try to influence the patient's decision in any way.
The appointment line will simply provide and explain the non-clinical information that helps the patient decide which provider to opt for.
Another way patients can make their appointments using Choose and Book is on the internet at www.nhs.uk. The Choose and Book option takes patients to Healthspace (www. healthspace.nhs.uk/ chooseand book/) where, by using their UBRN and password, they can book their appointment.
I expect this to become an increasingly popular method as more hospital systems become compliant.
By the middle of last month, well over 50 per cent of practices were connected to and using Choose and Book. Feedback from both GP and patient users has proved positive.
I have no regrets at leaving behind the snail trail of paper-based referrals, although there are still some challenges to be overcome and I will explore these over the next few weeks.
- Dr Davies is a West Yorkshire GP and national medical director (primary care) at NHS Connecting
- Next week: finding services and using the directory of services
ERADICATING CHOOSE AND BOOK MYTHS
'The workload impact is huge'
Choose and Book is about changing the way we work. It does not have a massive impact on workload, although there is some. Remember that Choose and Book means an end to dictated referral letters, freeing up GP and staff time.
GPs will need to talk to patients about their referral options but the booking process can take place after the GP consultation and, indeed, away from the surgery. Payments for taking on the directed enhanced services for choice and booking and for information management and technology should help to compensate practices as they implement Choose and Book.
'Maintaining confidentiality is difficult'
Unauthorised access to patient information is a common but misplaced concern. Referral information is normally only available to the GP making the referral. If the referral is made by a GP not at the practice where the patient is registered, the details are also made available to the patient's own GPs. Other practices cannot access the information. If a GP referral is marked 'content sensitive' the details can only be accessed by the referring GP.
PDS Personal demographic service for locating patient where practice system is not integrated with Choose and Book.
UBRN Unique booking reference number to give to the patient.
DBS Directly bookable services: for appointments that can be booked online.
IBS Indirectly bookable services: for appointments that cannot yet be made on line.
PAS Patient administration system (at hospitals).
CONSIDER THE FACTS ABOUT ONLINE BOOKING
- Paper-based referrals are outdated in the computer age. Choose and Book is more straightforward than GPs first think.
- Understanding the key tasks you have to undertake as a GP and which tasks can be processed outside the consultation will lessen anxiety about workload.
- Becoming familiar with parts of the system designed to support GPs and practice staff, such as the appointments line, will help you realise Choose and Book is manageable.
- As time goes on, more hospital systems will be compliant with Choose and Book making it possible to book more online appointments.
- Don't accept what other people tell you about Choose and Book: find out for yourself.
- Feedback from patients and clinicians who use the service is positive.
- Some challenges remain but after using Choose and Book, most GPs do not choose to go back to paper-based referrals.
- www.chooseandbook.nhs.uk - for general information.
- The Choose and Book lead at your PCT for local information.
- 'Choose and Book - making it work for you in primary care': a short film available on DVD (reference 2232) or CD (reference 2233). Tel 08453 700760 to order.