Choose and Book: my first impressions

Originally published in GP magazine .

Written for GP magazine around 2005. This is the version I submitted - the published article may have been edited.

First let me say I am not completely against the idea of Choose and Book using an e-booking solution. I actually quite like the idea of being able to bring up a list of all the local providers of a service and receive an idea of waiting times, and help my patient get the best out of the NHS.

I do however have big concerns with the amount of time, effort and money pumped into it and the way that it has been completely over-managed. In fact I don’t remember any other project that has as many middle managers involved holding innumerable meetings, briefings, workshops and events.

I have a hatred of the whole terminology that goes with Choose and Book. Constantly being told we aren’t piloting it, we are early adopters, when it was obvious they hadn’t got any software that works, is just a farce. More honesty and openness and less spin might engender greater support from GPs.

My view is that a good piece of software should be easy to use and not need any training. Our PCT recently introduced and rolled out a superb piece of software that does online blood test requesting and allows us to see results in the trust’s computer system. Everyone could see the benefits and it was rapidly deployed with only a few teething problems and none of the bad feelings associated with Choose and Book, as we felt it was there to help us, not complicate our lives.

So basically I have ignored it as much as possible - not easy when I am the GP lead for IT in our PCT. I haven’t been to any training events or done the online clickable demo, however with a week to go to our much put-off go-live date actually happening I have finally had a session. One of my 10 partners and I have agreed to use it to begin with, to get the process and system bugs sorted from an internal practice point of view. The PCT are happy with this as they can say we are live, thereby meeting their target.

My PCT is an early adopter of the e-booking solution. In some respects we are in a fortunate position, as every practice in the patch is on Emis and geographically most of our referrals go to one acute trust. To begin with we will only be booking to the one provider in four specialities, though they are hoping to expand the number rapidly. I am also looking forward to when we get real choice.

For the training a special computer was brought under armed guard, presumably as it’s the only one that it works on. My first impressions were: it looks OK, but what a silly way to log on, and the screen layout is haphazard.

Emis are apparently holding out for money before linking to the Choose and Book system. While I can understand this, I wonder if it’s the right policy, as somehow we have been talked into going ahead with the version that doesn’t link to Emis, and if we all get used to using it then why would anyone pay for the other version? However their strategy made more sense when it became clear that the address and demographics data on the system and spine were taken from Exeter and not our clinical system, and couldn’t in any way be guaranteed. This makes my first big headache: in order to use it we are going to have to waste time checking that the data on the system matches what we have on record. Also we will have to manually set a password for everyone before they can use the booking management system. Because of this, although two of us may use it, I don’t think any more will until the Emis link is activated.

In case you don’t know, there are three options available when making a referral in Choose and Book.

Do everything yourself in the consultation.

I realise there has been some near hysteria in the magazines about this. But in some situations I think this is fair enough. I certainly have consultations where the topic of the consultation is me wanting to refer the patient, either because I have run out of options or because the condition or results merit it. I also have consultations where people come in demanding a referral, sometimes appropriately.

I often discuss where they should go, waiting times etc. I am fortunate/unfortunate to have a lot of patients with private health insurance, and these consultations often turn into which hospital/consultant would be best to go to, and my patients are willing to travel to Birmingham, Manchester, Liverpool and Chester.

The important thing here is that none of us want to turn into travel agents, with a patient in front of us with their diary open going “oh I can’t make that week as I am having my hair done” etc. If the problem is urgent I can see that I would want to look up the appointment and tell them where and when it is. It might reduce those dreadful messages or calls where people ring up because they haven’t heard anything yet or the appointment is too far away.

Receptionist to do the booking after leaving the consultation or at a later date.

I have absolutely no problems with this, except it seems to me that my receptionist is now doing work that the hospital staff used to do. So I want the funding, including on-costs, to go with it. It isn’t my favourite option as the workload may be unpredictable and difficult to manage, but if funded well it may work, and there is the advantage that they can book transport etc at the same time.

Booking management service.

Possibly NHS Direct doing something useful for once. Patients take the slips from me with a unique booking reference number and a password. I have had to select which clinics I am happy for them to see, as above. I can specify one clinic if I particularly want a certain consultant, or any clinic in a speciality at any provider that my PCT contracts with.

It is worth mentioning here that many people have been worried about the lack of being able to refer to their favourite consultant. There is nothing in C&B that stops this. The trust decides how they are offering their clinics; if they have chosen only to offer generic referrals rather than individuals, it is the trust you need to speak to.

The patient is then offered appointments with whoever I have chosen when they ring. They can go home, check their diaries, calendars, spouses etc and ring and try to get a date that suits them. The BMS will contact them in a predefined time period if they haven’t rung first.

We were worried that providers would put false appointments early to generate bookings, then just cancel what were effectively unreal clinics. However we are assured that if this were to happen then the patient would have to be offered the full choice again of all the clinics you had ticked, not just at their site. This is possibly one reason for not being too selective when ticking boxes without good reason.

A lot of this is very dependent on the hospitals, and I don’t feel we have as much to feel threatened about as they do. For a lot of specialities I have no particular loyalty to my local trust, which I feel gives a poor service in many areas, and this may be the making or breaking of them.

I was disappointed with the software on my half hour’s play with it.

Logging on seems cumbersome. Insert a card and type in a password, which then launches an Internet Explorer window that you have to click something on, which then shuts down. You then have to open Internet Explorer again straight away and type in a web address and log in again by clicking OK to your name. This all seems stupid.

The user interface also seems inconsistent. Some things that you are meant to click on have down arrows on them. On one screen the most important thing to click on was surrounded by down arrows for other things but was just in bold and needed clicking on. Sometimes clicking brings up new pages, sometimes a popup window. Yellow highlights don’t show up as very yellow on my screen. It reminded me of a poorly designed website, or possibly something designed by committees that didn’t really talk to each other.

On the main screen where the outstanding tasks showed up you could only see two at a time, having to slide arrows backwards and forwards and up and down to see more - surely a waste of using a windows browser environment.

At this point the guy from Choose and Book in an expensive suit at the back, who no one introduced and seemed to be the heavy from the C&B team, muttered something about a new version coming out later in the year but wasn’t keen to be pushed on a date.

I was happy however that the secretaries’ task of appending referral letters to active referrals seemed to take about a minute and shouldn’t cause them too many problems.

I look forward to seeing what really happens when I get my card, though I have just heard it may be delayed another week.

Most important things I learnt:

Until the EMIS link is in place, checking patient demographics and giving everyone a password is going to be a real pain.

Need to keep records of how much reception time it is taking and make sure we get recompensed.

Logging-on method is cumbersome.

Secretaries are not going to have much trouble attaching referral letters to the bookings.

Heavily dependent on how well providers have set up their systems, e.g. names of clinics, slots devoted to C&B etc.