Choose and Book medical director Dr Stephen Miller explains the improvements to the latest version of the controversial electronic referral system
On 23 October 2010, NHS Connecting for Health released its latest version of the Choose and Book software to the NHS.
Although called ‘Release 5' this was actually the latest in a series of upgrades to the system, since Choose and Book went live in 2004, and was based very much on requested enhancements specified by groups of users within the NHS.
To date, over 25 million patient referrals have been made through Choose and Book. Each month this represents around 500,000 referrals being made from GP practices to first outpatient services. In addition, around 140,000 other referrals are made per month to services provided by Allied Health Professionals and GPs with special interests, as well as to diagnostic and clinical assessment services. This additional activity, over and above that originally intended, reflects the growing trend to move more patient care into community settings (care closer to home) and demonstrates the flexibility of the Choose and Book application, along with the readiness of referrers and providers to use Choose and Book for these services.
In Release 5, GPs will find several new features that should make the referral process much easier for them. For example, there is now a much more intuitive and logical way of searching for services using the (SNOMED) clinical terminology that was introduced in a previous release. With only a few clicks, it is now possible to enter clinical symptoms or diagnoses and to find suitable services that deal with such conditions located close to any named town or postcode anywhere in the country.
For GPs who are part of local commissioning initiatives (eg those set up under practice-based commissioning) it is now possible to define local services on Choose and Book and to restrict access to such services, so that only those practices that are part of the same commissioning group can refer directly. When used in conjunction with Clinical Assessment Services and Advice & Guidance functionality, it is possible for Choose and Book to operate very effectively to support local demand management initiatives, without directly restricting the referring rights of GPs.
Additionally, using the same new functionality, providers are now able to list some of their more specialist services on Choose and Book and to make them 'restricted' so that only authorised clinicians (eg GPSIs) or authorised organisations can access the service directly. Other (non-authorised) GPs will still see the service listed, but it will be marked as 'restricted' and an alternative care pathway will be indicated when trying to refer to that service.
The majority of the enhancements and features in Release 5 have come about as a result of direct feedback and requests from the NHS. The national Choose and Book team has always been very keen to listen to the requirements of patients and professionals alike and to reflect these in any new functionality. Choose and Book was always designed with clinicians in mind, but it is only once GPs and consultants become sufficiently familiar with the application that they feel confident enough to use it themselves and then start to realise its true benefits.
We know that an increasing number of GPs actually initiate the referral and book the appointment themselves, with the patient still in the consultation. Feedback from such colleagues suggests this results in much greater personal satisfaction (having completed the referral process themselves) as well as financial and efficiency savings in not delegating referral tasks to admin and support staff.
Within the central team, we fully recognise that Choose and Book has had some real challenges up to now in terms of the way in which it has been implemented locally. We know that GPs have not always found it easy to use the system, often because they have not been trained adequately or been helped to see the real benefits that it can bring.
Therefore, with Release 5, we have tried to make the application much more intuitive and have adopted different methods of training and educating users. Through a series of workshops and regular bulletins we have also tried to ensure that the changes we have introduced have been communicated more effectively. We understand the frustrations that many GPs and patients have when trying to book an appointment only to find that hospitals have failed to match demand with capacity, resulting in no appointments being available. Taking this on board we have now made it possible for the patient (or their GP), on finding no available appointments, to forward the referral directly to the hospital who must now take responsibility for contacting the patient within a few days and offer them a choice of appointments.
So what about the future? We are often asked about how Choose and Book fits in with new visions of healthcare delivery in the NHS. The recent health white paper describes increasing the use of Choose and Book, in line with increased patient choice. We believe that the application should be seen as a tool that can be used effectively to deliver quality, choice and commissioning objectives in line with the QIPP agenda.
Choose and Book already supports many of the choice ideas mentioned in the white paper (such as choice in mental health, diagnostics, and of named consultant-led team) and we are working with many local health communities to help them get as many of these services onto Choose and Book as possible. We are also exploring ways in which the electronic Directory of Services within Choose and Book (currently containing over 32,000 services) can be refined to act as a definitive source of commissioning information for the NHS.
We continue to receive positive feedback from colleagues within the NHS. This includes the following, received recently:
'Choose and Book is going to become an increasingly important tool for primary care commissioning' - Dr Richard Cullen, GP in Rotherham
'Secondary care clinicians support the best engagement with primary care and most efficient use of scarce resources – Choose and Book supports that' - Dr Keith Brent, consultant paediatrician
'Dentists look enviously at the functionality in Choose and Book and can't wait to be included' - Dr Jim Lafferty, General Dental Practice Committee, British Dental Association
'Advice and guidance has offered a new way of developing clinical management plans with secondary care that has prevented many of my patients (especially the frail and elderly) from attending hospital unnecessarily' - Dr Gillian Ellsbury, GP with Lambeth Commissioning Group
'The display of indicative waiting times is really useful in helping my patients to choose which hospital they want to attend' - Dr Malcolm Artley, GP in London
Dr Stephen Miller is the medical director of Choose and Book and a GP in Lambeth, southeast London.Dr Stephen Miller is medical director for Choose and Book Dr Stephen Miller is medical director for Choose and Book