The Adventurous 4.0

Dr Stephen Miller

Choose and Book’s national medical director, Dr Stephen Miller, outlines the latest developments to the online booking system.

Following the introduction of the Department of Health’s “free choice” policy in April 2008, the majority of patients referred for specialist care in England have been able to choose where they wish to be treated.

Choose and Book Release 4.0, which was implemented over the weekend of 3 and 4 May, has new functionality to support this policy. Release 4.0 is the culmination of many months of design, development, testing and implementation-planning. On the first day following the upgrade, a record 26,000 bookings were made.

Until April this year, secondary care services had to be commissioned by primary care trusts. With Release 4.0, commissioners are no longer able to define which services a referrer is shown, since, by default, all secondary care services are available.

(The exceptions to this are mental health, diagnostic, maternity and two week wait cancer services, which are not currently subject to free choice and may still need to be commissioned locally).

This means that GPs can use the new national Directory of Services to search the entire country for secondary care that is suitable for their patient’s condition. All such services must be listed on Choose and Book, if a hospital – NHS or independent sector – has a national contract with the NHS.

Patients continue to enjoy the certainty of being given an appointment, or the means to book an appointment, when they leave their GP’s surgery. They can also feel reassured that their referral details are being transferred safely and securely.

But free choice and Release 4.0 have provided a whole new range of choices and flexibility for them. I can see, for example, how an elderly person might want to be treated in a different area of the country, because they have family members there.

However, as with any new system, there are challenges. Recently, for example, there have been reports that hospitals have been reducing the number of appointments available to book via Choose and Book to try and meet 18 week referral to treatment waiting times.

Some trusts seem to believe that by not making appointments available very far in advance, they will somehow be better able to achieve these targets. This doesn’t work in practice, as the hospitals are still required to see all clinically appropriate patients referred to them; so they end up having to book appointments outside Choose and Book.

This can be frustrating and confusing to both patients and their GPs. The National Choose and Book team, along with colleagues in strategic health authorities (SHAs), have been constantly monitoring the situation. New guidance has been written and released to the NHS. We very much hope that trusts will use this guidance to rapidly resolve this problem.

The Choose and Book team also hears regularly from GPs and consultants frustrated that they cannot use the system for referrals to named specialists. However, the truth is that the application can deal with named consultant referrals. Where there is a local need, hospitals should seriously consider making this functionality available – especially if they have traditionally accepted paper referrals to named individuals.

So what of the future? Additional functionality will enable doctors to search for services by coded, clinical terms (SNOMED). They will be able to enter, for example, diseases, symptoms or findings relevant to their patients and be presented with services that match their requirements.

Diagnostic services, already available on Choose and Book, will be further developed and associated with clinical request templates, either locally or nationally defined, that a referrer will complete within the application.

Choose and Book is constantly growing and evolving and we therefore need to ensure that we are continuing to engage with clinicians in a productive way, producing a system which really does meet everyday needs and is robust enough to take on the potential that wider patient-choice brings.

To help us do this, each SHA region has its own Choose and Book User Group which meets regularly and sends a representative to the National Design Steering Group to help formally consider refinements to the application.

Additionally, we have a SHA Choose and Book Forum, which considers more of the strategic and implementation issues that arise. We also rely very much on advice from clinical colleagues who belong to the National Clinical Reference Panel and the National Speciality Reference Group – both made up of doctors and other clinicians independent of NHS Connecting for Health.

We know from evidence that Choose and Book uptake and use is always highest where communities work together and where there is strong local leadership. We therefore very strongly encourage local health communities to get together and discuss how to make Choose and Book work best for them.

We also feel it important to regularly remind users of the training and implementation guidance that we have produced, which is all easily located on our website: http://www.chooseandbook.nhs.uk/staff

Choose and Book is not an “off the shelf” product. By working with colleagues, listening to their needs and very much focusing on our patients, we hope to continue to develop an electronic booking system that is fit for the 21st Century NHS – and one that becomes the standard, everyday method of referral.

CHOOSE AND BOOK STATISTICS

• 98% of all GP practices are live and able to use Choose and Book, and 91% are now regularly using the system.

• Around 50% of all referrals are made via Choose and Book

• More than 10 million bookings have now been made through Choose and Book.