Technical problems with Choose and Book dog GPs

Frustrations with Choose and Book including problems reconciling GP records with the personal demographics service have prompted some GPs to stop using the service and led a local medical committee to recommend its practices do not use the system.

Sheffield LMC has advised its members not to take part in the choice and booking directed enhanced service (DES). A motion passed at its last meeting reads: “Sheffield LMC believes that choose and book in Sheffield is currently not fit for purpose and the LMC would therefore have grave reservations in recommending practices to sign up for the DES in its current form."

However a statement from Connecting for Health provided to EHI Primary Care says “there are no outstanding major national technical issues with Choose and Book that should prevent GPs from using the service.” The statement adds: “Feedback from GPs using the service continues to be positive, and especially so since the implementation of Choose and Book release 3.0 at the end of April.”

In Hertfordshire practices have reported a problem with the Personal Demographics Service (PDS). Patients’ names held on GP systems are queried against the PDS, which then puts in an extra initial duplicating any second first names so that, for example, John Peter Smith appears on the PDS as John Peter P Smith. In each case practices are then asked to verify which name is correct.

Philip Eaton, practice manager at the Harvey House Surgery in St Albans, said the PDS problem affected all practice work, not just Choose and Book, since once the smartcard was placed in a practice computer all patient details were automatically checked against the PDS.

He told EHI Primary Care: “It doesn’t do it with every patient on the system but is a significant number and makes it more time-consuming for staff and doctors. I have raised it with EMIS, our system supplier, who raised it with CfH who raised it with BT and it looks like it will take a significant amount of time to put right.”

A spokesperson for CfH told EHI Primary Care that the problem with middle initials/names on the PDS was a “known issue” affecting all systems connecting to the PDS, not just Choose and Book. He said it affected about 10% of records held on the PDS.

The spokesperson added: “NHS Connecting for Health acknowledges that this can cause some inconvenience to practices, however, local work-arounds are in place to overcome this issue and a permanent national fix is being implemented before the end of June 2006.”

Dr Mike Walton, a GP at the Harvey House Surgery, said the problem with initials was “another irritation” GPs were facing with the Choose and Book system. He added: “It’s not ubiquitous but it happens very commonly and I can’t believe there isn’t some sort of programme they can run to sort this out.”

Dr Walton said his practice was still committed in principle to the Choice and Booking DES but said there was no chance practices in his area would meet the first target of 25% of referrals to be made through Choose and Book in June.

He added: “The infrastructure isn’t there and although in the few cases where it’s worked well patients have been moderately impressed by it there are still far too many bugs in the system.”

Dr Trefor Roscoe, a GP in Sheffield and member of the BMA’s General Practitioner Committee, said Sheffield LMC had decided to advise GPs not to take part in the Choose and Book DES after local PCTs tried to adapt the nationally agreed DES following problems with Choose and Book in secondary care. Dr Roscoe said local hospitals had loaded fewer than 10% of hospital clinics on to the system so no practices had a hope of achieving the DES targets.

He told EHI Primary Care: “The motion is sending a very important message that this system has got serious problems, those problems are much worse in Sheffield and why on earth should we struggle with it.”

A spokesperson for CfH said the problems in CfH were a “business process issue” which the local health community was working to address.

He added: “Usage of Choose and Book continues to increase at a steady pace. As at close of business on Monday, 15 May, over 375,000 patient appointments had been made using Choose and Book at a current rate of about 30,000 per week. This means that on a daily basis, thousands of patients are benefiting from Choose and Book across the country and on Monday, 15 May 6,792 patients used the service – this is the highest daily total so far.”

The problem with initials, combined with a series of other frustrations with Choose and Book, has led Dr Alan Ferris, a GP at a practice in Potters Bar, Hertfordshire, to stop using the system.

He said the final straw came over a 91-year-old patient who was happy to use Choose and Book. Dr Ferris gave the patient a password and unique booking reference number to make her booking via the system from home as all the local hospitals are currently offering indirectly bookable services only.

Dr Ferris said: “She had to speak to four different people and then the hospital told her they can’t find her referral on the system but it quite clearly is there and I can see it from my computer.”

Dr Ferris said other concerns included the problems with the extra initial created by the PDS which he estimated affected about a third of his patients, problems where clinics were on the Choose and Book system when the referral was made but then subsequently taken off by the hospital which meant patients returned to the practice and problems where patients had returned with a message from the hospital saying a fax would get them a quicker appointment.

He told EHI Primary Care: “I don’t mind putting up with a bit of extra work if its improving the service to patients but I feel at the moment it’s actually a worse service and it also discriminates against housebound patients. I’ve switched the system off and I won’t be switching it back on unless someone can show me a significant improvement in the service.”