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MedEconomics: Finance - How to... refer using Choose and Book

Accessing providers and making the referral may be less complicated than you think, says Debbie Andalo.

GPs have been wary of Choose and Book, the online referral system for England. Uptake by practices has been slow due to teething troubles with the software and GPs' concerns about additional workload. However, with patient choice and Choose and Book falling under new directed enhanced services (DESs) from 1 April for a year and possibly longer, there is greater incentive to use the system. By last month, 285 PCTs out of 303 had the Choose and Book system and 3,000 referrals a day were being made.

DES payments

The choice and booking DES will pay practices meeting the requirements up to 96p per patient. The new information technology adoption DES, which includes using Choose and Book, will pay a maximum of £1.33 per patient.

For full details, see 'Revisions to the GMS contract 2006/7: delivering investment in general practice', at www.nhsemployers.org or www.bma.org.uk.

Local provider directories

PCTs have compiled local directories of providers they have contracts with to help GPs offer patients choice. These should be available as hard copies for each practice and the Choose and Book software also includes them.

Using the software

The software enables GPs to log on to a provider's appointment system so the patient knows which slots are available on which dates. The patient can then select an appointment that can be booked and confirmed online.

However, only 35 per cent of Choose and Book referrals are currently booked online because some hospital trusts' systems are incompatible with the software. According to Connecting for Health, the NHS's national IT programme, this problem should be resolved by the end of 2006.

Whether the detailed appointment is made or just the referral decision, the patient is given a unique booking reference number (UBRN), a password and a national Choose and Book advice line number together with a printed statement confirming their referral. Patients who do not choose an appointment while at the surgery can use their UBRN and password and make the appointment either by phone or the internet at www.nhs.uk. So far only 3 per cent of bookings by patients are via the internet.

The GP can track all Choose and Book referrals by searching their personal work-list page. Choose and Book also allows GPs to email consultants for advice before deciding whether to make a referral.

Although the GP makes the clinical decision to refer the patient, either the GP or a practice staff member can book the appointment online using their own smartcard to access the system.

Confidentiality preserved

Details of the patient's condition are only available to those directly involved in the referral; that is the GP practice and the clinic or consultant.

However, patients' demographic data can be seen by anyone with a smartcard and pass code to the system, but Connecting for Health says it is training staff about confidentiality and security.


Single-handed GP Dr Mark Sanghera in County Durham has used Choose and Book since last October to make an average of five referrals a day.

A swipe of his personal smartcard followed by keying in his security PIN number opens the window to the system. Dr Sanghera enters the patient's NHS number and confirms the patient's details. Next he goes to the required specialty, chooses the appropriate clinical option and a list of providers appears. Getting to this point takes about 30 seconds, he says.

He discusses the providers with the patient. When the patient has chosen, Dr Sanghera clicks on the submit box and prints a letter confirming the referral. The system does not yet allow him to make an appointment with all providers. If he cannot book online, he gives the patient the details they need (see main text) to make the appointment themselves.

Dr Sanghera finds that patients tend to choose the same provider that they would have gone to before Choose and Book.

'I don't think it is such an advantage for patient choice, but the patient can see that the referral has been made,' he says.

He believes GPs should use the system. 'It doesn't take much time. I think this system will mean fewer missed appointments,' he says.

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