Slow progress on Choose and Book

Uptake of Choose and Book has made slow progress since the beginning of this year, according to latest figures from Connecting for Health.

Statistics for the week ending 16 July show that England’s electronic referral and booking system is being used for almost 40% of NHS referrals for first consultant outpatient appointments, two percentage points higher than the 37% booking figure achieved in March and a similar figure recorded in January.

Daily booking figures seen by EHI Primary Care show a small increase over the last three months with totals on most weekdays of between 16,000 and 19,000. Bookings have only exceeded 20,000 on two days, however, one at the end of April and one in the middle of May. The Department of Health’s target continues to be for the e-booking system to be used for 90% of first outpatient appointments.

Board reports to this month’s meetings of strategic health authorities show that primary care trusts are likely to face increasing pressure to deliver higher figures.

At NHS North West SHA a report from Joe Rafferty, director of commissioning and performance says use of Choose and Book in the region is currently 43% against a national average of 40%, but with a wide range of performance between primary care trusts varying from 80% to 15%.

“The SHA is working with the Department of Health Intensive Support Team focusing on PCTs with poor performance," the report adds.

Even in North East SHA, the best performing SHA in England with 47% of referrals made via Choose and Book in May compared to 39% nationwide, the SHA acknowledges the difficulties. A report from the Audit Commission on choice and Choose and Book in the North-east recommended that issues relating to variable PCT achievement were addressed within a robust SHA-wide performance management framework.

In Avon Bath and North-east Somerset PCT’s professional executive committee recently sent a letter to GP practices outlining the PCT’s position at 142 out of 152 PCTs on Choose and Book performance and raising the prospect, although later discounting it, of a threat to the status of PMS practices if Choose and Book uptake did not improve.

Dr Simon Bradley, chairman of Avon Local Medical Committee, told EHI Primary Care: “The PEC’s view was that it was a badly written letter than implied pressure where none was intended.”

Dr Bradley said that across Avon, traditionally one of the lowest users of Choose and Book, practices were facing encouragement rather than pressure to use Choose and Book.

He said PCTs had agreed variations on the directed enhanced service (DES) for Choose and Book which rewarded practices to run the scheme as an e-booking system administered by practice staff with no need for a discussion on choice.

He added: “About 18 months ago it was not fit for purpose but it has gradually become more so, and although there are still problems with the integrated version I believe the web-based booking service is fit for purpose.”

Dr Bradley added: “Use of Choose and Book was rising, it then dropped and stabilised and it’s probably creeping up a bit now.”

Dr Bradley said there was no need for GPs to have a discussion with patients on choice as the only clinical information available, on MRSA rates, was not sufficiently detailed to allow a meaningful discussion.

He added: “You don’t need a clinical conversation to talk about waiting times, parking and hotel services.”