Choose and Book set to miss 90% referral target

Tags: Birmingham booking Choose and Book DH GP GPs London PAS PCT PCTs SHA South

10 Oct 2006

The Department of Health’s target for 90% of referrals to be made through Choose and Book by next March looks almost certain to be missed, as latest figures reveal every strategic health authority is behind schedule.

The statistics show that while the average percentage of bookings made through the system is now 27%, many primary care trusts are still in single figures making the achievement of a 90% target by all 150 new PCTs highly unlikely.

Figures reported to the September board meetings of the new SHAs show that in the case of the worst performing authorities less than half of the planned bookings had been made through the system during the summer. In South East Coast SHA 12% of outpatient bookings went through Choose and Book in August compared to the projected 28%, and in the East of England 13% of bookings went through Choose and Book, only just over a third of the 35% the SHA said it hoped to achieve by that stage.

The figures for August from South East Coast SHA include some trusts that performed well, such as Croydon, which achieved 28% of referrals through the system. However, eight of the 25 old-style PCTs had used Choose and Book for 5% or less of referrals with East Elmbridge and Mid-Surrey PCT referring no patients through the system and East Surrey PCT only 1%.

However a spokesperson for the Department of Health told EHI Primary Care: ""Some PCTs are making very good progress already and this demonstrates it [the 90% target] can be achieved"

Dr Pat Phillips, medical director of Surrey and Sussex LMCs, blamed the low take-up on a variety of factors.

She told EHI Primary Care: “Some of it is down to technical problems PCTs and practices have faced, in some cases hospitals have not had their Directory of Services up and running and there are still some problems with clinical engagement. I think reaching the 90% target will be unlikely in some PCTs.”

Even one of the most successful SHAs in the country, the North East, which achieved 41% of referrals through the system in the last week of September, was several percentage points below its trajectory for September of 49.5%.

A spokesperson for North East SHA told EHI primary Care: “We remain as confident as we can be of achieving the 90% target in March 2007.”

A report to the September meeting of the London SHA board by Terry Hanafin, director of performance, revealed that 22% of bookings were made via Choose and Book in August against a trajectory of 35%. The report said the range of performance among PCTs was from 3% to 80% with 27 trusts referring between 12% and 29% of patients through Choose and Book.

It added: “There are a number of issues affecting performance nationally such as trusts not making enough appointment slots available on the Choose and Book system, operational problems with call centres and the extent of GP engagement. These are also issues we need to address in London.”

In the West Midlands South Birmingham PCT was the worst performing trust with 10% of referrals going through Choose and Book in August compared to between 17% and 42% of referrals for all other trusts.

Nick Dunaway, director of IT for the trust told the board that the poor performance could be attributed to a number of factors including low GP commitment in some practices, a dispute with the DH on the basis of the trajectory and the introduction of new patient administration systems (PAS) in Birmingham hospitals by Connecting for Health.

The report adds: “On Trusts previous PAS systems the call centre operators would normally have to navigate between 3 and 4 screens in order to register the patient, add the referral and then make the booking. This usually took between 3 and 7 minutes. Unfortunately the introduction of the new PAS’s has had an adverse impact on this process which now takes an additional 8 – 10 minutes, therefore the average time it takes to make a booking has increased to around 16 minutes."

Statistics for July from south Central SHA show 11 of the 16 PCTs were below trajectory at that point with significant underperformers including Buckinghamshire, the Isle of Wight and Oxfordshire whose performance in July was 0.9% against a project 15.5%.

However a spokesperson for NHS South Central told EHI Primary Care that the latest validated figures it had for Choose and Book related to June when performance was 17.8% against a trajectory of 16.2%.

He added: “Roll out of Choose & Book is a high priority to all organisations in South Central and we are making every effort to achieve the target of 90% by end March 2007.”

Last week Dr Mark Davies, primary care medical director for the national Choose and Book team, wrote to GP newspaper that 25% of referrals were now going through Choose and Book.

He added: “Clearly the 90 per cent target for PCTs is ambitious but we should be congratulating GPs for the progress they have made to date.”

The DH spokesperson said the latest weekly data available is for the week ending Sunday 1 October 2006 when 46,903 outpatient referrals went through C&B representing 27% of all outpatient referrals.

No choose and no book - patient's view

11 Oct 06 10:10

I needed referral for an old injury (exacerbated by an accident caused by a health care professional) but because of choose and book cannot be seen by the team who have treated me for years. My 'choice' was the service that caused the injury or another service. I have tried calling the service (no online appts) every day since I was referred (early Sept). The message is the same - too busy use email. Email is undeliverable (mailbox exceeded limit). The GP is penalized for not using Choose and Book by the PCT. Choose and Book's call center told me I was stupid and slammed down the phone on me. So, the patient needing care is denied continuity of care and cannot even get through to book an appointment. Is Choose and Book a new scam for keeping down waiting times and meeting targets by denying patients access?

A new, unheard of, definition of 'efficiency'

14 Oct 06 17:10

My experiences with CAB vary from the acute side to the GP originator.

The GPs hate it - they all complain of being asked to be travel agents and also qoute the excessive time to use the system.

The GP admin staff hate it because its so damn slow and unreliable and takes forever to get letters attached and then duplicated to be stored in their own more efficient system.

When the referral gets to an acute (hospital) call centre, the caller has have details taken down onto paper and called back - about 2-5 days later.

The operator has to open CAB, locate the referal details, add them to the paper record. Then open the CRS software and manually register the patient, create a referal, modify the priority, and attempt to book the appointment. At this point the patient has to be called back, they are not usually available by now. So a dummy appointment is made and they are asked to call back and modify the appointment if not suitable. At this point - they may not get their preferred location because the call centre is not aware of the specific details of the patients choice. There is roughly a backlog of 30 to 40 of these CAB appointments, each one takes 30 minutes to complete, thats in between the queue of regular callers on the same line.

My advice as an insider and an occasional appointment is refuse the CAB option, the GPs will like you, the appointment is faster and your choice gets known faster and more efficiently.

The physical ability to link the CAB and CRS software is about 4-6 years away according to a senior Software supplier contact.

When we supplied the CAB system to GPs, they were told the system would be fully bookable within a year. That's in the same catagory of stuff that Bulls leave behind in their paddock.

Choose and Book Target

25 Oct 06 09:10

I like the way people are quick to bring down Choose and Book. Yes, i agree that every system will have its faults. The Post office will go on strike, Airlines will over book seats or there will be delays due to bad weather etc. , people will fall ill. We do not live in a perfect world. Choose and Book has brought about a lot of change, yes, GP will be resistant to working with a system which is sometimes slow. Referral letters need to be attached and it may take a bit more time initially, but in the long term, there will be benefits. Hospitals will not need to ask GP's to fax letters through because someone in the Hospital has "lost" it. The letter once uploaded is ON THE SYSTEM. Lets give all those who have worked hard to implementing Choose and Book a pat on the back. It has not been easy. We are still working on improving the way GP's work and this is an on going process. Anyone else out there see my point of view?

Anyone else out there see my point of view?

28 Oct 06 14:10

I actually do work with the system from its inception and the promises of efficiency have never been delivered. The example of the letter being attached to the referral does not ring true.

The hospital call centre has to accept the CAB booking in order to unfreeze the referral letter and the Hospital Consultant to read it, they do not have the software to read it electronically, so it has to be printed. Then the appointment already made (to unlock the letter) may have to be re-made, re-directed or declined. Another session in the call centre results in another 2 day loss and the patient would have been better off asking for the conventional route to be used.

I can't find a single person ( GP, PCT or Acute) who likes the system because it is simply unfinished !