BMA sits on critical Choose and Book survey results

The British Medical Association has decided not to publish its own survey of Choose and Book which is highly critical of the e-booking system. A copy of the survey has, however, been obtained by EHI Primary Care.

At the beginning of February BMA chairman Mr James Johnson promised the survey would be published “shortly” but EHI Primary Care has now learnt that the association has changed its mind.

A spokesperson told EHI Primary Care: “We are not publishing the survey as we feel it does not move things on any further. We will, however, continue to monitor how members feel about Choose and Book.”

The existence of the survey was revealed by Mr Johnson six weeks ago at a joint Connecting for Health and BMA conference on IT. He told the conference that the survey, which he promised would be published shortly, showed that Choose and Book was “overwhelmingly unpopular” with GPs and consultants.

The decision not to publish the survey is in contrast to earlier highly public criticism of the e-booking system from within the association. GP representatives at last year’s annual local medical committees conference passed a motion describing Choose and Book as “deeply flawed and not fit for purpose” and a year earlier Mr Johnson himself told the BMA’s annual conference that Choose and Book was a “fiasco”.

The unpublished survey of 279 GPs and 128 consultants carried out between 30 November 2006 and 10 January this year shows that members’ views have changed little since then. Of those who responded to the survey, 78% of GPs and 77% of consultants said they currently used Choose and Book.

A total of 57 % of GPs and 81% of consultants described their experience of Choose and Book over the previous month as negative or very negative and 87% of consultants and 71% of GPs said they would not recommend Choose and Book to a colleague.

Asked about whether patient choice had improved with Choose and Book the majority of GPs (68%) reported that in their view it had not as did 56% of consultants with a further 30% of consultants saying that they did not know.

Consultants appear to be even unhappier with the e-booking system’s impact on patients than GPs with almost 92% of consultants disagreeing or strongly disagreeing with the statement that patient feedback had been generally positive compared to 64% of GPs.

A total of 65% of GPs in the survey did not think the system was user friendly and 69% did not think it was reliable either. On a slightly more positive note 87% of GPs reported that patients generally get the choice they want but 84% disagreed or strongly with the statement that Choose and Book gave them more control over the referral process. Just over 1% of consultants felt that the management of referrals had improved.

When asked to identify the benefits of Choose and Book to patients, 67 % of GPs strongly agreed or agreed with the statement that it allows patient more certainty over when an appointment will be compared with 54 % of consultants. However two thirds of GPs and consultants reported that they strongly disagreed or disagreed with the statement that Choose and Book provides improved patient safety as referrals did not get lost or that Choose and Book provides improved patient safety as they are less likely to not attend.

The survey was commissioned by the BMA’s working party on NHS IT to gather the views of GPs and consultants about the scheme to inform discussion with Connecting for Health and the Department of Health on Choose and Book.

The association posted 1000 questionnaires to consultants and 1000 to GPs and had replies from 128 consultants and 279 GPs.

Only 19% of GPs felt that the Directory of Services (DoS) was accurate with a further 41% reporting they believed the DoS was not very accurate. Just under one in five GPs (19%) said an improved DoS would help the efficiency of Choose and Book.

On the hospital side, engagement with consultants on Choose and Book would still appear to be an issue. The survey found that almost half of consultants (46%) did not know if their department had an entry on the DoS and 28% said referrals via Choose and Book could be made more efficient by a better understanding of the process by all involved.

When asked if there was enough IT support to help them effectively use Choose and Book only 28% of GPs and 7% of consultants agreed that there was. GPs said their main source of advice and support on Choose and Book was their colleagues whereas consultants’ main source of support was their trust. The two areas which GPs believed had caused them the most problems with the Choose and Book system in the last month were the speed of the online system and availability of services to refer to, both of which were highlighted by 18% of GPs.

GPs and consultants were asked to identify reasons behind the need to rebook appointments – 38% of GPs felt that the number of referrals sent back had increased under Choose and Book.

A total of 26% of GPs said rebooking was necessary because of hospital rescheduling of appointments and 24% said rebooking was necessary because of an inability to refer to a named consultant. More than a quarter (28%) of consultants said the most likely reasons for rebooking an appointment were that the referral was incorrect, with 20% saying rebooking happened when the priority of the referral was incorrect.

A majority of GPs (51%) reported that consultation length had significantly increased as a result of using Choose and Book. and consultants who were not using Choose and Book were able to add their own comments about why not.

One GP commented: “We have just decided to stop, having been in the top 100 practices for usage, as the local hospital has started to tell patients that there are no appointments available, when the patient rings to book, and asking the patient to contact our practice! – what are we supposed to do?’ Another said: “Complaints from patients over difficulties in getting through . . . all of this fed back to me in wasted surgery time.”