GP referrals made under Choose and Book have topped the 20,000 mark on a curve that is “rising but delayed”, a conference heard.
Richard Gibbs, a Connecting for Health (CfH) executive lead for Choose and Book, said bookings were now being made at the rate of over 700 per day but he added: “If all GPs were using Choose and Book that figure should be over 20,000.”
Dr Gibbs, a former chair of the NHS chief executives’ IT forum, explained that the challenges had occurred not within the booking software itself but in joining systems together.
“A lot of the technical problems we faced were interfacing issues,” he told a Choose and Book session at the British Journal of Healthcare Computing and Information Management Autumn Forum.
“Hard pressed NHS IT staff have faced the challenge of having to fix these things,” he said.
He added that there had also been intermittent performance and reliability problems at local and national level.
Dr Gibbs said much of the early adopters’ experience had been drawn together into a toolkit available on the Choose and Book website and in hard copy form.
He observed that when things went wrong people tended to think there was a problem with the national system when it was often a local issue. In response to this an escalation process has been devised which helps users to pinpoint a problem more easily.
Role-specific guidance was also now available for all players in the Choose and Book process including consultants, GPs, project managers and practice managers.
What have we learned, asked Dr Gibbs? “Leadership is vital. Choose and Book does not work unless boards and trusts have it high on their agenda.” Champions, too, were needed. “Once you’ve got the people who can see the benefits, use them.”
The main challenge, he explained was the need to line up a whole host of people and systems: GPs, hospitals, booking staff, suppliers and so on. “There’s no one single thing that’s difficult. The challenge is that you have to do a lot of things with a lot of people.”
CfH clinical lead, Dr Sebastian Alexander, a GP in Cambridge, reflected on the current, non-electronic referral process involving dictation, transcription, typing, checking, posting a letter to the hospital and receiving a response from the hospital.
It was, he said, a tortuous process that could take up to 28 days in his area. “This is why I’m involved in this programme,” he said.
Dr Alexander said the current system involved him chasing a lot of referrals, offered limited or no choice to patients, made it difficult to access information about services, had no system to support referral protocols, made it difficult to track what was going on and raised questions about patient confidentiality with lots of paper around.
Choose and Book solved many of these issues offering choice to patients about the date and time of an appointment, quick information about details of the appointment, the option to change the date and generally more certainty and less worry.
For GPs, he said Choose and Book meant you were no longer the sole source of information, administrative time was reduced, there was decision support for the referral, advice and guidance on facilities, greater visibility of and insight into the care pathway and improved clinical safety because letters did not get lost.