A great leap forward

Stephen Miller, national medical director for Choose and Book, explains why Choose and Book is transforming the clinician-patient relationship-it all starts in the GP’s surgery when referring the patient to a specialist

Modernising the NHS with the aid of technology is something that will have touched the many people who have received medical treatment during the last few years.

The National Programme for IT is an ambitious programme. Computers are now a part of our everyday lives that it makes perfect sense to harness that progress and turn it into real benefits in the healthcare setting. There are many different parts of this program being delivered by NHS Connecting for Health in supporting the NHS to introduce new computer systems. Some of these innovations are readily embraced such as PACS, with all x-rays and imaging techniques becoming digital, for example, heralding the end of wet films and lost images.

As our daily lives are linked from start to finish with technology, the same now is also true of medical interactions and patient journeys. For most patients, their GP and local surgery is the starting point and this is where they are introduced to the new electronic referral service, Choose and Book.

For the first time, electronic referrals are available which combine electronic booking with a choice of place, date and time for a patient’s first outpatient appointment.

Booking appointments has long been an area of keen focus for the NHS. Appointment cards would get mislaid, letters became lost, patients often didn’t attend clinics. A new, more efficient system was needed to give patients choice, flexibility and control. Many of my patients have responded positively to this new service. They also have greater certainty and peace of mind at a time which may be very stressful for them.

Once the patient has an appointment request letter they can book their appointment in a number of different ways:

Phone the appointments line on 0845 60 88888

Visit the website www.healthspace.nhs.uk/chooseandbook

With their GP or a member of the practice team

Phone the hospital or clinic of their choice directly to book their appointment

Since the introduction of Choose and Book, over 6 million patients have been referred to specialist care. Just over a year ago it was one million. All primary care trusts throughout the country are now ‘live’ with Choose and Book with some using the system to make over 70% of their referrals. On a weekly basis, well over three quarters (90%) of all GP surgeries make an appointment via the system. On average, 52% of all outpatient referrals are currently being made through Choose and Book.

It is true that these are new and challenging times for the NHS, but there are clear benefits to patients in terms of convenience in making appointments for their onward care.

Choose and Book has further benefits for the NHS, too. Trusts are reporting how the system has contributed to reducing Did Not Attend rates where missed hospital appointments have been cut by approximately a third and waiting times have been reduced by 9 working days from the date of referral to the start of patient care. Trusts are also reporting that Choose and Book is helping to deliver the 18-week pathway.

The British Medical Association has supported Choose and Book with new guidance issued in 2007 on how to use the system effectively. We have always had useful and constructive dialogue with the BMA. Their practical comments help influence future development of the Choose and Book programme. It is agreed that real progress can be made as we move towards a paperless system across the NHS with a strong emphasis on partnership working between the Choose and Book programme and end users, especially clinicians and patients. For this to be truly effective, further enhancements to functionality will continue to be part of the inbuilt process.

Choose and Book is subject to progressive review and development involving a number of key stakeholder groups who meet regularly such as the Design Steering Group and National Clinical Reference Panel. The Royal Colleges also contribute via the National Speciality Reference Group, and patients feed in through the Choose and Book User Group.

There are ongoing challenges to ensure that progress on Choose and Book is maintained.

These include improving the knowledge of all GPs and staff regarding the functionality of the Choose and Book application in particular in relation to key word searches and named consultant referrals-the latter is dependent on local providers and commissioners making this functionality available. Other challenges include eliminating problems with slot availability where providers have not released sufficient appointment slots to meet patient demand.

Some GPs have concerns over the actual time the system takes and its potential to add to the length of a consultation rather than reduce it and make it more efficient. Again, this is simply about ways of working and how we incorporate modern technology into our practices. For example, I have my computer ready with my smartcard installed at the beginning of clinics before I start to see patients. It is then prepared and active for when I need to refer to it with a patient in front of me. Choose and Book provides greater responsibility and control of referrals and how we interact with our patients and clinical colleagues.

We want to encourage greater use of Choose and Book amongst secondary care colleagues.

Secondary care also needs to play its part in bringing the full usability and take-up of the system to fruition. This involves ensuring that all hardware and software is correctly configured and installed. Smartcards need to be issued and activated. Improved usage means increased familiarity – something which benefits all those involved.

The forthcoming Release 4.0 will deliver new enhancements for users. Support for Free Choice is being incorporated as is support for diagnostics and searching for services under coded keywords. These are all new features which will prove advantageous.

Other challenges include local ownership and PCT leadership, both of which are vital. Some PCTs are making Choose and Book a clear priority by realising the efficiencies of the electronic referral process and recognising the consistent patient benefits such a process brings. In many settings technology factors such as local IT configuration, which are within the control of PCTs, contribute to concerns or frustrations over delivery, and it is only right that PCTs are stepping forward to manage that part of the process with transparency.

Patients can be given certainty over the dates and times of upcoming appointments and can also be advised on what tests they need to take prior to the appointment. There is a sense of clinical satisfaction in knowing you have helped them onto the next stage of the journey with clarity and assurance. There is no dependence on the post or telephone answering machines.

Everyone has a role in the ongoing development and evolution of Choose and Book, because it is for everybody – clinicians, non-clinicians and patients alike. Considerable improvements have been made thanks to constant feedback from clinicians and practitioners who see the benefits of the system and outline how it might be improved further.

Choose and Book represents a dramatic step forward in the way we interact with our patients, and introduces control and flexibility for them which they never had before. This is a great example of how we can use the power of technology to improve patient care.