GPs and consultants are still struggling to make Choose and Book work as intended, according to new research carried out by the British Medical Association.
Problems with system reliability, slot availability and the time involved in making or reviewing an appointment are all highlighted in the association’s latest report, Choose and Book – learning lessons from local experience.
The BMA said it decided to investigate local experiences at one PCT with large variations in usage – Hammersmith and Fulham – after receiving mixed reports from doctors all over the country about the success of Choose and Book
The BMA carried out 16 interviews with GPs, consultants, managers and administrators. “Some are very positive and would be unwilling to revert to paper-based referrals. Others find it completely unworkable,” the report says.
The researchers found GPs liked being able to give patients control of their appointment and that administrators liked being able to track the progress of referrals.
One GP commented: “When the system is working well it is amazing. The referral letter and appointment are made while the patient is sitting there.”
However, they found that even the most enthusiastic GPs sometimes struggled to find clinics on the system and with reliability. One practice reported that it took as long as 30 minutes to re-boot their systems following a crash. However, it was acknowledged that the problems were often with local systems rather than with the Choose and Book application.
And the research found that in many cases appointment booking had been delegated to administrative staff. The BMA said it was concerned about staff who were not clinically trained selecting the appropriate clinic and that practices that used this method should monitor closely the number of rejected or redirected referrals.
The report found that consultants found the system slow, but that it rarely crashed for them. However, it also found that only a “tiny minority” of consultants were using the system to review appointments. Most appointments were printed off by the central booking office and sent for the consultant to review.
The report says: “Potential benefits – including letters not going missing, a clear audit trail, confidential exchange of information directly between clinicians and a reduction in administration – are largely lost when the letters are printed out and sent back and forward between the booking office and consultant.”
Dr Chaand Nagpaul, a GP and member of the BMA’s Working Party on IT, said that when Choose and Book works well it helps with the referral process. But he added: “When it goes wrong, it is extremely frustrating – to the extent that some doctors find it is not worth using. Trusts and PCTs must ensure that systems are fit for purpose. For their part, doctors can help improve the systems by recording and reporting problems.”
An action group was set up involving the BMA, the Department of Health, NHS Connecting for Health, the PCT, the local hospital trust and local clinicians following the research. The BMA reported that progress was being made as a result, which highlighted the importance of local communications.
The BMA has also made a series of recommendations as a result of its research, including greater collaboration between primary and secondary care, local discussions to define how clinics are included on the Directory of Services to suit local needs and a named contact at the PCT and trust so users can seek help within an agreed timescale when experiencing problems.