Not quite on target

Fiona Barr

Like the little girl with a little curl, a fair summary of the government’s electronic appointment booking system might be that when it is good it is very, very good but when it is bad it is horrid.

That means that while 27% of bookings are now being delivered via Choose and Book, the system has yet to tick all the boxes that would be necessary to get 90% of referrals through the system by March next year as the health department had hoped.

Patients, practices and hospitals using Choose and Book have had to cope with not one overwhelming problem but by a series of difficulties that have made it frustrating or even impossible to operate in some cases.

Difficulties have included getting the software installed and working in practices, providing enough bandwidth to use the e-referral system effectively, setting up and maintaining an efficient telephone call centre operation and being able to access clinics and appointments onto the Directory of Services.

Clinical engagement

On top of this, engagement of the key operators of the system, GPs, has been a struggle.

Dr Pat Phillips, medical director at Surrey and Sussex LMCs, works in an area where some PCTs were already referring close to 30% of patients through the system in August while others failed to use it at all.

She says: “Clinical engagement is always going to be a problem, certainly until everything in secondary care is Choose and Book-able. Some services are on Choose and Book and some aren’t so you can end up in a consultation saying yes you can go there, no you can’t. I think it will only really work when the system is a lot more robust than it is now and all the services are on there.”

It is not just GPs and practice staff who need more encouragement to sign up. A report to the East of England SHA board from interim chief information officer Graham Folmer says that while almost all technical issues have now been resolved, PCTs need to work with GPs and their staff to get the service fully implemented.

Folmer said: “It is fair to say that the strength of Choose and Book leadership in PCTs over the last 12 months has been highly variable. The SHA will ensure that incoming PCT Chief Executives recognise this as one of their prime responsibilities.”

Unattainable

On the positive side there is no doubt that, when it works well, Choose and Book is popular with both patients and GPs and that substantial progress will be made by the end of the year. It is clear from the figures, however, that a target of 90% will be unattainable. SHA board reports reveal every authority is behind schedule.

In some cases, for example East Elmbridge and Mid Surrey PCT, a specialist primary care referral system has been up and running for some time and since such referrals are not included in Choose and Book, uptake is inevitably affected.

In Bath and North East Somerset SHA an existing popular e-referral system has provided a secure internet referral system into the Royal United Hospital, Bath since 2000.

The PCT, which is currently referring 18% of patients through the system against an expected 50%, is now predicting that at best it can achieve 40-50% utlisation of Choose and Book by the end of March. It is now considering withdrawing the e-referral system by the end of February.

A remaining incentive for all PCTs is that those who achieve 90% uptake by the end of December stand to earn a £100,000 incentive payment. A year ago just one PCT, Durham Dales, managed to reach the target for 50% of referrals by December 2005. It would be surprising if more than a handful do so again this time.