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Andy Jones

Choose and book

I am no longer a novice when it comes to the Choose and Book computer set-up.

I have negotiated the paperwork, have been issued with a smart card, and have endured the training sessions explaining the quirks of the system.

But I am not finding things easy. In fact, having read the comments of Richard Granger, director of the project, who says that the £6.2 billion system is on the brink of collapse, I worry that I might be the one who finally pushes it over the edge.

Take logging on, for example. I have got this down to 19 keystrokes, navigating through four pop-up screens, but it still takes an average of 10 minutes for my PC to become at one with the NHS spine and crashes happen nearly every day. Also the system frequently freezes.

Admittedly I get to check the address and details of every patient passing though my door, but even here the system is hardly user friendly. If, for example, the practice receptionists opt for the grammatically correct Mr. or Mrs., the computer can't handle this since it has been programmed to recognise only Mr or Mrs without the points. So before seeing my next patient I have to confirm the changes with the spine. This is in addition to having to clear the new contract reminders and have a quick scan of the notes. All very time-consuming.

Then there's the referral itself. I have a patient who has uncontrolled acne. We discussed treatment and a range of referral options. We engaged the system and made an electronic referral to a mutually agreed physician. I printed off the reference number with password and 33 minutes later the patient left!

I look back with longing to those pre-Choose and Book days when I could have said to him: 'I'm afraid I'm out of lotions and ideas, just nip along and see the specialist at the local hospital.'

The fact is that Choose and Book has been dogged from the start by disagreements with software providers and by confusion over the system's specification. The latest spat has been generated by the providers bemoaning the 'consistently late requests' for specification changes long after contracts had been agreed from the Department of Health.

It is worth remembering that the original idea behind Choose and Book was based on electronic booking using an American billing software programme. But additional things have been bolted on, for example the addition of choice, and this has compromised performance.

The Economist magazine recently suggested the complexities and failings of modern software were holding back the development of health care. Choose and Book specifications suggest the system should take 42 seconds to access, with an end- to-end referral taking less than 85 seconds!

I recently took 15 minutes over an end-to-end referral process. Unless I can get down to 85 seconds pretty quickly, along with 37,000 colleagues nationwide, we're in big trouble.

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