GPs highlight “clunky” functionality of C+B

The Choose and Book system is "clunky and cumbersome" and slower than the paper-based referral mechanism it is intended to replace, according to GPs.

In a survey of 40 practices undertaken by the GP magazine Pulse, respondents complained of lack of standardisation and speed of the internet browser-based software.

Dr Patrick Clarke, a GP in Burnham in Buckinghamshire, told the magazine: "Allegedly it is supposed to add 37 seconds onto referral times . But it seems to add 5 minutes. The more I do it the faster I get but I can’t see being able to shave more than a minute off."

Others reported delays of up to 45 minutes in getting through the screens, and a number objected to too many keystrokes and steps.

NHS Connecting for Health told Pulse that it was not planning to review the software.

The sentiments were echoed in GPs comments in the recent Medix-UK survey into the implementation of the National Programme for IT co-sponsored by EHI primary Care, which was published this month.

One GP told the Medix-UK survey that Choose and Book’s interface was hindering GPs, rather than helping them: "The user interfaces have not been designed in concert with the users (ie. the doctors) and are therefore too cumbersome; in some cases this results in a slower system than the "paper" office they aim to replace."

Another said: “Our 8,000 patient practice has just had its IT system ‘upgraded’ for Choose & Book. However the system has become slower and more prone to crash.”

GPs called the system overcomplicated and also criticised training and feedback about the workings of the system.

Another added: "We expressed concerns that the Choose and Book service was too slow and had too many steps. We piloted Choose and Book a year later and sure enough it took 20 minutes to refer… an unacceptable amount of time just to simply request an appointment."

Choose and Book has also come into criticism through its reliance of pop-up windows, worrying some users that because they have to disable blocking software in order to access the system the security of their computers are at risk.

The downloadable, ‘unplugged’ version of Choose and Book, which allows users to try out the functionality of the system with test patient data, is available from the Choose and Book site at www.chooseandbook.nhs.uk/staff/training/unplugged.

A spokesperson for CfH told EHI Primary Care: "The Pulse survey is based on a reasonably small sample size. Of those GPs who were sent the questionnaire 12 responded. Their observations should be viewed in the context that we now have several thousand GPs using Choose and Book. Between them they have already made well over 100,000 bookings through the system."

The C&B system had undergone extensive testing, explained CfH, with supplier Atos Origin testing the service standalone as part of the procurement process before the contract was awarded. "Clinicians were invited to review and evaluate the proposed electronic booking solutions by running through a range of different booking scenarios. In this evaluation exercise Atos Origin’s application outperformed the solutions presented by the other suppliers."

"Feedback from users, and from timings of how long it takes to make a booking, show that Choose and Book is efficient, easy to use and flexible," said CfH. "Timings have consistently shown that Choose and Book takes an average of 90-100 seconds for an end to end direct booking transaction when the PC and local networks through which Choose and Book is being used are configured correctly, and the user has been trained with the application."

CfH disagreed that pop-up windows were prevalent throughout the application and compromised security. "It runs in a ‘kiosk’ window; this is a normal way to provide increased security and improved usability for such applications by removing the browser toolbars and navigation buttons. The initial opening in a kiosk window is the only use of the "popup" technique in Choose and Book.

"Security is not at risk because the standard browser configuration allows trusted applications such as Choose and Book to execute in this way without opening up vulnerabilities, as the popup blocker does not need to be disabled."