Choose and Book fails to offer choice

05 Aug 2008

Choose and Book failed to deliver its promise of choice of hospital, time and date of appointment, a newly-published study shows.

Researchers from University College London’s Centre for Health Informatics and Multiprofessional Education (CHIME) questioned more than 100 patients referred to Hillingdon Hospital, London, either via Choose and Book or using a paper-based system.

The researchers found that 66% of those referred via Choose and Book were not given a choice of date for their outpatient appointment, 66% said they were not given a choice of appointment time and 86% reported being given a choice of fewer than four hospitals.

However a spokesperson for Connecting for Health told EHI Primary Care that the study was not a reflection of present experiences. He said: “Today Choose and Book has had more than 10 million bookings and the UCL study of 104 patients from a single hospital, two years ago, does not reflect the experience of most users.”

The study was conducted between May and August 2006 with patients identified by Hillingdon Hospital’s patient administration system and interviewed at the hospital while waiting for their outpatient hospital.

Dr Henry Potts from UCL’s CHIME oversaw the study and said it was clear from the results that patients were not experiencing the degree of choice that Choose and Book was designed to deliver.

He added: “This may be only one hospital, with results taken in a transitional period, but we believe this could be typical of the national picture.

“It is striking that nobody, up until to this point, has actually asked patients about their experience of the system. These results show the reality of what’s happening on the ground, surely vital when it comes to measuring to what extent this is working or not. This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”

The data showed that 63% of patients were not aware before their GP appointment that they were entitled to choose to which hospital they were referred. The researchers questioned 47 patients who had been referred via Choose and Book and 57 who had been referred using a ‘partial booking’ system which meant the referral was sent from the GP on paper and the hospital then wrote to the patients asking them to ring and make an appointment.

In comparison with the partial booking system patients using Choose and Book did report being offered a greater choice of hospital but were no more likely to be offered a choice of time or date of appointment.

Those who had booked their appointment online or via a call centre using Choose and Book were also more likely to report being offered choice than those who had booked their appointment via Choose and Book using their GP surgeries.

The spokesperson for CfH added: “Any patient receiving routine elective treatment is now able to choose from any NHS approved hospital provider in England. A part of this, the electronic referral system, Choose and Book, allows patients to choose their outpatient appointment according to their own priorities - whether that is the first available date, the hospital closest to their home, or fitting their appointment around their family or work commitments.

”Recent major surveys on patient choice and primary care consistently show the number of patients using Choose and Book and being offered a service continues to steadily increase. Choose and Book is used for around 50% of all GP referrals to first outpatient appointment. 98% of GP practices have Choose and Book and currently 92% are using it for referrals."

Fiona Barr

Reader's Comments

Misleading article

05 Aug 08 13:08

This is such an annoying article. Choose and Book doesn't offer choice, it supports choice! If GPs fail to give a patient choice of provider or book the appointment for the patient it isn't the application that's failing it's the GP!

Remember a bad workman blames his tools.

72,000 responses

05 Aug 08 14:08

here's a link to the latest DH survey re choice

http://tinyurl.com/3w9pon

Flavours of Choose and Book?

05 Aug 08 15:08

Not my specialist area but doesn't choose and book come in several different guises?

1. patient leaves the GP surgery with their appointment place and time in the bag - all done

2. patient leaves the GP surgery with a phone number to call to fix the appointment

plus other permutations including snail mail

It's hardly ever made clear which of these we are talking about when choose and book statistics are wheeled out. I wonder why?

This tells an important story

05 Aug 08 22:08

>>66% of those referred via Choose and Book were not given a choice of date for their outpatient appointment, 66% said they were not given a choice of appointment time and 86% reported being given a choice of fewer than four hospitals.<<

The CaB application doesn't (nor was it expected to) achieve the above by itself.

It needs GPs who are prepared to acknowledge that maybe the patient might just have reasons to choose one patient over another, and Hospitals who are prepared to discuss a convenient date & time with the patient.

For GPs and Hospitals who want to involve the patient in the process, CaB can provide options we never had before.

This research shows how many NHS bodies are treating patients like cattle. (I was going to say taking the p**s)

Many GPs and Hospitals have got the message, but some still seem to think the patient should fit around the service.

My local hospital had a habit of sending me brown envelopes telling me to turn up the following day at an hour I couldn't possibly accommodate.

I now choose one that gives me options. In time, the word will get around and patients will vote with their feet (and that includes choosing a GP too).

Meanwhile, blaming Choose and Book for this is like blaming an aerosol can for graffitti.

blame the GPs - as usual

cunpr@globalnet.co.uk

06 Aug 08 15:08

....and none of the respondents acknowledge that patients may well have been offered all of these choices by their GP but denied them by 2ry care. A good many "appointments" on C&B don't actually exist or cannot be booked or are cancelled or unilateraly changed by the hospital after the initial booking. C&B supports choice for patients and GPs alike but it is nirvana as far as hospitals are concerned as a tool for manipulating and controlling access to secondary care and waiting list targets. I'm a GP and I've tried it and stopped using it for this very reason.

A bad workman or a dubious design?

daryl.mullen@nhs.net

06 Aug 08 17:08

To the commentor who states that GPs are failing to give patients a choice when using CAB most GPs will be wondering what planet the management are on. GPs have no axe to grind when it comes to choice, frankly we don't mind where the patient chooses as long as the service is clinically good. The problem with CAB is that hospitals typically lack capacity to release slots to CAB for us to then book. The result is that after attempting to use the notoriously unreliable CAB application, waiting for it to load, one then discovers no appointments are available. The patient is then left with either phoning and hoping at some point slots become bookable or asking the GP to revert to the old system.

Before blaming us the workmen you might like to ask us what its like actually trying to use the damn thing