E-booking to miss its appointment

Almost 15-months after the award of a five-year £64.5m contract to Schlumberger-Sema (since taken over by Atos Origin), the programme is now to introduce two additional interim systems offering limited functionality as it apparently struggles to achieve the 2005 target for electronic appointments to be available. 

The national programme denies that Choose and Book was to be delivered across England by the end of 2005. In a statement to EHI it said: “A fully integrated Choose and Book service will not, and was never expected to, be available in all health communities by the end of 2005.  Nevertheless, we are planning on making it widely available by the end of 2005 as it still represents the most effective way of meeting the booking target."

NPfIT’s position however appears at odds with previous DH statements.  In October 2003 the DH stated: “Implementation of the national electronic booking programme is expected to be completed by the end of 2005.” The NHS Plan, and Department’s Planning and Priorities framework is also unequivocal “Electronic booking will be implemented by 2005."

The new guidance letter, issued three days before Christmas, says that some strategic health authorities (SHAs) and primary care trusts are having to explore using paper-based interim solutions. “This is because the fully integrated Choose and Book solution will not be available in all health economies by December 2005 (given projected timescales for replacement/upgrade of GP IT systems and hospital PAS systems)".

The letter from Margaret Edwards, the DH’s director of access, sets out what it terms a “re-focused” approach for the roll-out of Choose and Book.  It advises SHAs to “work on the assumption that GP IT systems will not necessarily be compliant by December 2005 and that current LSP and Existing Provider Plans for PAS upgrades/replacements apply."   

The letter announces that NPfIT will introduce two interim Choose and Book systems, which will not provide the full functionality of the national solution being delivered by Atos Origin.  In primary care this will take the shape of a stand-alone, web-based version “where GP systems are not compliant". 

This web-based stop gap, first reported by E-Health Insider in November, will not be fully integrated with hospital patient administration systems (PAS) and in many cases will still require referral letters to be sent manually to hospitals.

A second interim solution for use in hospitals will provide a list of hospital clinic appointment choices but will not display “actual appointment dates and times”. If a patient chooses one of these clinics, without knowing when the appointment would be, the system will not be able to then book an appointment.  "Where a patient chooses one of these services, appointments cannot be booked,” Edward’s letter states.

This ‘choose but not book’ system will instead rely on hospitals contacting a patient to agree a time and date for a chosen appointment.  Services booked in this way are termed “Indirectly Booked Services (IBS)".  

“The web-based Choose and Book service is planned to be ready by the end of February 2005 and the IBS solution by the end of May 2005," says the guidance.

In addition to introducing the interim Choose and Book solutions the DH will shift the goalposts on how it measures take-up and use of Choose and Book systems.  The Edwards letter says the DH will no longer distinguish between ‘full’ and ‘partial’ manual booking in its performance measurement of the utilisation of Choose and Book.  

Dr Richard Vautrey, a member of the BMA’s general practitioner committee told EHI that whether the 2005 Choose and Book target will be achieved now looked to be largely a question of definition.  “They could define it as just one process in each health community."

Dr John Powell, chair of the BMA’s IT committee, told EHI he thought Choose and Book was the wrong service to start with but had been prioritised due to pressure from politicians for results.  “Personally I think Choose and Book was the wrong element of the programme to tackle first, there are higher priorities."

In a November 2004 interview, NHS IT Director General Richard Granger, told the Financial Times that NPfIT remained on target to help meet the December 2005 target for a fully booked NHS.  He told the FT:  “We are not behind for achieving the roll out… the core technology is in and it works.” He also stated that delays were “nothing to do with the technology".