Choose and Book increases DNAs

Attendance in outpatient clinics is worse for patients referred via Choose and Book than for those given an appointment after a traditional GP referral, according to a new study.

Hospital doctors at University Hospital Lewisham compared 700 patients who had been referred via the electronic booking system with the same number of patients referred on paper.

They found a did-not-attend (DNA) rate of 18% for Choose and Book referrals compared to 12% for traditional GP referrals, according to a letter sent to the BMJ.

Dr Prince Cheriyan Modayil and fellow registrars from the ENT department at University Hospital Lewisham decided to investigate the figures after anecdotal feedback from their consultant, David Bowdler.

Dr Modayil told EHI Primary Care: “We would expect most of the patients who come through Choose and Book to turn up, but Mr Bowdler was seeing a different pattern so we decided to look at the cancellations and came up with figures that are statistically significant.”

Mr Bowdler told EHI Primary Care: "The view from the shop floor is that this is a bad top down system imposed by the government but although I had an instinct about the DNAs I was still surprised by the results. "

Mr Bowlder said it was impossible to say why the DNAs were higher but said he thought patients were sometimes booked in toa  clinic with the lowest waiting time through Choose and Book and then discovered it was further away than their local hopsital and opted not to travel. He said there was also too little information on Choose and Book to allow proper targetting of referrals to the right specialists.

Dr Modayil said the pilot study would be followed up by more work to examine why patients did not attend.

He added: “We are going to look in more detail at the cancellations, including if patients have cancelled before, how many times they have cancelled and what sort of problems these patients have.”

Dr Modayil said it was too soon to pinpoint the reasons behind the differences in DNA rates but pointed to research last year that showed most patients referred through Choose and Book were not experiencing a significant choice in appointment time, date or hospital.

In the letter to the BMJ the doctors added: “Choose and Book has failed to achieve its main goal of improving patients’ satisfaction and attendance. Moreover, it creates an unnecessary economic burden on the health system and jeopardises the prioritisation process by removing clinicians from the process.”

However the Department of Health said it was surprised by the study’s findings as it said all other evidence suggested Choose and Book significantly reduces DNA rates.

A DH spokesperson added: "It is logical that if a patient is actively involved in
decisions about their care, attendance is likely to improve. We note that
further research is being undertaken to test these findings and seek an
explanation for them."