Choose and Book’s new champion

Dr Stephen Miller, Choose and Book’s new medical director, remains confident that Connecting for Health’s (CfH) e-booking system, despite making slow progress currently, will one day become the complete and usual method of referral.

To get from 40% to 90%, however, Dr Miller accepts that much work will need to be done including more work on refining the system and more clinical engagement.

He says: “We need to listen to people in practices which is the key to understanding where the barriers are in terms of usage.”

Dr Miller’s has long-standing experience of electronic booking. A GP in South-east London for 12 years he got involved in electronic booking via the booked admission project with King’s College Hospital in 1999.

He then became clinical lead for an award-winning area wide electronic booking system in South-east London in 2002/3, took part in the procurement process for the national supplier for Choose and Book, was choice and booking lead for South East London Strategic Health Authority (SHA) for three years and last year chaired the national reference group for Choose and Book.

He adds: “I applied to become medical director this year because I think Choose and Book is still a very exciting new development within the NHS, there’s a lot to be done and I could see a challenge I could rise to.”

That challenge will include working with organisations such as the British Medical Association’s General Practitioner Committee whose policy agreed at this summer’s local medical committees’ conference is that Choose and Book is currently not fit for purpose.

Dr Miller prefers to take a more positive message away from the conference in that representatives rejected a call for the system to be suspended.

He says: “I certainly think Choose and Book is fit for purpose. We have managed to book 4.4m appointments. What we have to do now is make it an every day means of referral that people don’t think about, to make it work for everybody all the time.”

One of the common complaints about Choose and Book is that it is slow and unreliable. The Choose and Book team has consistently claimed that this is not a problem with the software itself but down to local configuration problems

To identify how well the Choose and Book application is performing as well as all the components of the system and environments that it operates within CfH has begun to use a transaction performance monitoring system called YourView.

Dr Miller says YourView is currently installed at 400 PCs in GP surgeries and consultants desks to provide information and help in the diagnosis and resolution of problems.

Dr Miller says one of the problems the Choose and Book team must overcome is to tackle both the real and perceived issues with the system and potential ignorance about the way the system has developed. Dr Miller says changes in functionality and usability based on users’ requests are being constantly fed into the system from a variety of sources including user groups within each of the ten SHAs, a design user group and a clinical reference group.

He adds: “A lot of them have this image of this static application and that’s the wrong message.”

Choose and Book has one major release each year followed by three or four minor upgrades. Changes in the pipeline for release four, due in March or April next year, include the ability to search for services using SNOMED codes and an extension of the director of services to enable patients to choose from any provider in England to deliver the government’s policy of free choice at referral.

The functionality of the system is also the subject of development and Dr Miller accepts that utilisation would improve if everything was bookable.

“In my own practice one of the first complaints is that not everything is available to be booked.”

Two week waits, diagnostics and mental health are all in the process of coming online with the top priority to get 100% of first consultant outpatient appointments on the system plus diagnostics which has been raised up the priority list in support of the 18 week referral to treatment target.

Dr Miller says another potential development to the functionality, booking into primary care, is not high on the priority list at the moment.

Latest statistics from CfH show that, as of July 23, 40% of referrals were being made through Choose and Book but with a huge variety in performance between primary care trusts with some delivering very small percentages of referrals through the system while others total 70, 80 or 90%.

Dr Miller argues that if some areas can deliver 90% uptake then other PCTs should eventually be able to follow suit.

“I think it is possible although I don’t know what the timescale will be,” he says.

Dr Miller believes word of mouth is important and wants to see SHAs and trusts taking responsibility for their communities using the system and taking an active role in promoting it.

“It’s where there’s been less NHS local leadership that there has been less uptake,” he says.

In his own practice Choose and Book is used for more than 70% of bookings and Dr Miller says he completes the whole process, including generating the booking reference number and typing and attaching the referral letter, within three or four minutes.

He cites the advantages for himself and his colleagues in time saving and job satisfaction when a patient leaves the consulting room with their booking made or appointment details in hand.

“The more you use it the more you want to use it,” he claims.