PCT achieves 87% C+B referrals with flexible system

A primary care trust (PCT) has achieved the highest take up of Choose and Book in the country by allowing practices to send Choose and Book information through the post.

The “medical secretary” model used by all PCTs in Somerset has helped GP practices in Somerset Coast PCT make 87% of referrals through Choose and Book in June and led to an uptake rate of more than 50% of referrals through Choose and Book for the whole county.

The system means patients leave practices without a unique booking reference number (UBRN) or an appointment. Instead GPs discuss choice options with patients in the consultation and record those options on a choice pro forma. The patient leaves with written information about their next steps and the GP dictates the referral letter as normal. A secretary then types the referral letter, logs the referral onto the Choose and Book system, prints out the unique booking reference number (UBRN) and posts to the patient in 48 hours with an explanatory letter and leaflet.

According to Kevin Hudson, programme manager for Choose and Book in Somerset, the system has been approved by the South West Strategic Health Authority and is being carried out with the full knowledge of the Department of Health.

Hudson told EHI Primary Care: “The SHA has approved our method and we have been quite open about it with the Department of Health. Our feeling is that an adapted method is better than no method at all and that, using the gold standard method, it’s quite difficult to get above 50%.”

Hudson said the model allowed patients to go through the Choose and Book system while building “thinking time” into the system for practices. The “gold standard” requires the referral and booking process to be completed during the patient’s visit to the surgery.

He added: “We found what was more important to patients was what happened downstream in terms of getting a time and date for their appointment rather than getting a UBRN in their hand when they leave the surgery.”

Hudson said that one of Somerset’s PCTs, Taunton Deane, had been an accelerated roll-out site for Choose and Book but even here it had been difficult to get much beyond 50% for referrals using the gold standard method.

He added: “Practices use a mixed method so that they use it [Choose and Book] live in the consultation where they can and where they can’t, which can be for a variety of reasons, they can use the medical secretary method which allows the medical secretaries and administration teams in practices to build up expertise to support the GPs.”

Somerset also runs its own booking management service (BMS) and Hudson says patient surveys have shown 90% satisfaction with the Choose and Book system as offered in the county.

He added: “One of the questions we asked was how well informed patients felt before calling the BMS and the medical secretary method actually produced better results, probably because there is only so much information you can give in a 10 minute consultation, whereas with this method you get more documentation and time to sit down and understand it.”

Hudson said the system had also proved popular with GPs, particularly those working in larger practices with established administrative functions.

Hudson said he was confident that Somerset PCTs would achieve their target of 90% of referrals through Choose and Book by the end of the year and that the Choose and Book team would work closely with individual practices to help them achieve their directed enhanced service targets which mean each practice has to be making at least 50% of referrals through Choose and Book between September and the end of February.

He added: “What is pleasing is that our June data shows that as well as achieving 50% referrals for the whole county, more than 50% of practices are over that 50% mark. The beauty of this system is also that it is not a slow build – you can go from doing nothing one week to everything the next.”