Search the website

Choose and book

January 2007

This briefing paper applies to England only.

Contents
Overview
Process
BMA Position
Background
Benefits
Drawbacks
Further Information

Overview
Choose and Book is an electronic booking system, which allows patients in England to choose the location, time and date of their hospital or clinic appointment when they are referred by a GP. It is a central part of the Government’s plans for modernising the NHS and brings together the key policy areas of patient choice, access, reducing waiting lists and IT investment.

Process
After the GP has discussed the options as to which hospitals/clinics are available to provide the treatment, the GP uses the Choose and Book electronic system to generate an appointment request (URBN) and a password for the patient. If the patient does not make a choice of provider at that time, the GP provides the patient with information about the clinically appropriate choices. The patient can then book the appointment at a later time using either the Choose and Book appointments telephone line, website, or contacting the hospital of choice directly. Alternatively, in some GP practices, the receptionist or secretary can make the appointment on the patient’s behalf.

BMA Position
The BMA welcomes any development which improves patient care and the working practices of GPs. The BMA also welcomes the opportunity for patients to be more involved in deciding where they are referred to and when they will be seen. However, the BMA is concerned about the workload and resource implications of Choose and Book, particularly relating to the additional time it takes to explain choice to patients, and then use the electronic booking system. Typically, this can follow a more complex consultation where the result has been that a referral is required. Most GP appointments are an average of ten minutes long and additional elements added to the consultation such as the “choice conversation” and use of an electronic booking system can adversely affect the quality of that consultation because of the time they take to complete.

The BMA has been working with the Department of Health and the National Programme for IT to try to resolve these issues. It is understandable that practices will carefully consider the implications of being involved in Choose and Book. The use of Choose and Book is not part of a GP’s contractual obligations and, therefore, practices can decline to be involved. A Directed Enhanced Service (DES) to encourage the use of Choose and Book by practices was introduced in April 2006.

The BMA supports the idea of choice and believes that patients should have the right to choose. However, if choice is to be offered it needs to be genuine and meaningful. The BMA would wish to see a return to the situation where GPs have the ability to refer their patients anywhere in the country without restriction by primary care trust (PCT) commissioning arrangements. Choice should not be skewed by demand management initiatives such as referral management centres (go to reference 1 here) or only available to those who have the money or mobility to travel to the hospitals with the best reputations.

Background

• Choose and Book was introduced across England in 2004 and will eventually be available to all patients.
• From 1 January 2006, a choice of at least four clinical providers has been offered. Choice was further extended in April 2006 when referrals to all Independent Sector Treatment Centres (ISTCs) and Foundation Trusts became possible.
• Choose and Book allows appointments to be booked up to 13 weeks in advance.
• Some 25% of GP referrals to hospitals and clinics are now managed through the Choose and Book electronic system.

Benefits

• Greater levels of information for patients about local services
• Ability to give the patient a booked time and date convenient to them
• Ability to track referrals
• Ability to send referrals electronically and more securely than paper referrals.

Drawbacks

• Increased workload for GP practices
• Spending time on a choice discussion when, often, patients want to be referred to a local facilitiy
• Possibility of booking in to the wrong clinic
• Giving an inappropriate waiting time to patients (a consultant could bring forward urgent cases on the basis of the referral letter if a booking has not already been made)
• Hospitals that still offer only partial or indirect booking (i.e. they send you an appointment time)
• Slowness in the system e.g. processing booked appointments etc
• Lack of appointments for local services that have reached their full capacity.

Reference:
1. Referral management centres receive referrals from primary care. In addition to analysing referral data (as do the more basic referral information services), the centres may fulfil a number of other roles: providing a link with patient booking services; deciding the treatment route for patients (including deciding between types of provider, e.g. consultant, GP with Special Interest (GPwSI), specialist nurse or alternative health provider); triage referrals.

Further Information:
Further information can be found on the Choose & Book website - http://www.chooseandbook.nhs.uk/