The online NHS patient appointment booking service Choose and Book is being used for about 50% of referrals according to Connecting for Health.

This marks a significant milestone in the use of the e-booking service, which has now been used for more than six million referrals. All the more impressive given that just over a year ago barely one million referrals had occurred through the system

Dr Stephen Miller, the medical director of Choose and Book, told EHI Primary Care that use of the system was now “…going along at about 110,000 referrals a week”.

According to Connecting for Health, all PCTs throughout the country are now ‘live’ with Choose and Book. Every week about three-quarters of all GP surgeries make an appointment using the system.

For much of 2006 usage of Choose and Book was stuck at around 40%, but provisional figures from CfH indicate usage is on the up.

“It’s now up to about 50%, for the past two weeks,” Dr Miller told EHI PC. “But we’re cautious about that figure and not making too much fuss about it.”

Asked why usage had appeared stuck at 40% for a number of months Dr Miller said. “There are different factors, it may be influenced by other issues such as GP pay and how it fits with other priorities such as 18-week waits.”

He added: “People are beginning to see that the Choose and Book application itself does work. What holds it back is local configuration and policy issues. These things have been giving it a bad name.”

Dr Miller said: “I think clinicians and the NHS are now beginning to cut a path on making Choose and Book the everyday method of referral across the NHS.”

The directed enhanced service (DES) for choice and booking ends in March, which could have a negative impact on use of the service.

“The DES is a consideration, any incentivisation helps,” said Dr Miller. “But there has to come a point at which this is everyday normal practice.”

Dr Miller said that Choose and Book was changing to meet these new policy requirements, particularly ‘Free Choice’, which from April requires offering patients an unrestricted choice of all private and public providers willing to deliver care in line with the NHS tariff.

To date few patients have chosen private provider options through Choose and Book and some private hospital groups complain that private options are not currently clearly visible to them.

“Free choice comes in from April and Choose and Book has to change to support that,” says Dr Miller. He said from April the software will offer two menus, one of primary care services and one of all secondary care services available. Patients will also be given two search options: to search just the services commissioned by their PCT, or all services listed.

One of the other key ways CfH is trying to sell Choose and Book to PCTs and trusts is as a tool to help them achieve 18-week waits, though Dr Miller admits this isn’t always getting through.

Dr Miller said that challenges remained with Choose and Book. These include improving the knowledge of all clinicians and staff regarding the functionality of the Choose and Book application in particular in relation to key word searches and named consultant referrals, which depends on local providers and commissioners.

Other challenges include eliminating problems with slot availability where providers have not released sufficient appointment slots to meet patient demand.