Bucking the trend

Fiona Barr

The Department of Health’s drive to implement Choose and Book has been a challenge some health communities have been determined to meet. One of the most successful areas so far has been Sunderland in the north east.

At the end of last month the primary care trust (PCT) delivered 56% of first consultant outpatient referrals through the system and now has it sights firmly set on the prize of 90% of referrals being made via Choose and Book by March next year.

As EHI Primary Care revealed last week the 90% figure is a target which is highly unlikely to be met universally. This makes the achievements of Sunderland and other PCTs who are already over the 50% mark all the more impressive.

Sunderland was also one of the larger PCTs under the pre-October 1 configuration, with 47 practices covering a population of 283,000. It remained as a PCT after the re-organisation.

Senior sponsorship

Darrin Shaw, programme manager for the IM&T Modernisation and Reform Programme at the PCT, accredits the trust’s success so far to a combination of factors.

He told EHIPC the Choose and Book project in Sunderland had executive-level sponsorship from both the PCT and provider, which has meant the project benefited from senior commitment and direction to achieve the project goals.

The project is run by a core community-wide team of staff from the PCT and City Hospitals Sunderland, the main local provider, which has enabled processes to be designed and agreed across the patient pathway and allowed for faster and clearer issue resolution.

The PCT has also benefited from the commitment of their local provider. Shaw added: “We have an extremely close relationship with City Hospitals Sunderland which has been one of the keys to our success.”

The project team’s planning approach has also focused on stakeholder engagement and Shaw says the team is working closely with GP practices to highlight the benefits of Choose and Book and support practices during implementation and after go-live which he says is extremely important: “Technical aspects of Choose and Book can be complicated so support in fixing issues and identifying training gaps has been essential in ensuring that once a practice is live, they stay live.”

The PCT has also set up a GP superuser group which meets monthly to discuss best practice for Choose and Book.

Shaw explained: “This forum allows users to share experiences, concerns and issues as well as allowing a communication channel for the PCT to provide training on future releases and raise key messages around Choose and Book.”

Original vision

The PCT says it has received genuine positive feedback from patients and practices about Choose and Book. Comments from practice staff have appreciated the benefits to patients as well as the advantages of delivering referral letters electronically.

It can also genuinely claim to be delivering what was the original vision of Choose and Book, that is appointments booked in the GP surgery. The PCT does not have a booking management service and appointments are booked either by GPs in consultation or by medical secretaries following dictation. The 47 practices in Sunderland use a combination of web-based and integrated software provided by EMIS and InPS.

Another common gripe about Choose and Book has been that hospitals have not put all their clinics on the Directory of Services (DoS) and that even if they have GPs have found it hard to locate the right clinic to book.

Shaw says the DoS is fully loaded with criteria completed for each service specific booking guidance. In addition City Hospitals Sunderland has invested both clinical and administrative resources to populate the keyword search within the DoS.

The PCT has not rested on its laurels and is also using Choose and Book across an extended range of services that are not currently counted as part of the DH targets – for example, booking for PCT-led services such as dermatology. The trust is also planning to bring NHS dentists within the scope of the project and allow them to make referrals through Choose and Book.

Shaw says the PCT is working extremely hard to meet the DH targets and the trajectories it submitted to its SHA. The current focus includes work with the SHA and the local provider to bring on board services such as cancer two week waits which are currently not available via Choose and Book in the North East.

He adds: “It is essential that those services currently not available in Choose and Book are made available to ensure that Sunderland, like all PCTs in the North East, can hit the 90% target.”

Whatever happens the PCT’s commitment to what is one of the DH’s top six priorities for 2006/7 remains undimmed.