Hospitals, primary care trusts and GP practices are being urged to reconsider workarounds for Choose and Book in favour of following national guidelines on implementation.

The Department of Health has issued new guidance on “the correct use” of the electronic booking system, covering such as how it should be used by individual clinicians, referral management services, availability of appointment slots and technical problems.

Dr Stephen Miller, national medical director for Choose and Book, said there was widespread variation in use, but those areas using the system as it had been intended were more likely to achieve high uptake rates and deliver a better experience for patients and professionals.

He told EHI Primary Care: “It’s not a question of telling people what to do, but I hope local health communities will take this guidance, examine what they are doing themselves, look at why they are doing it in that way, and consider changing if necessary.”

The guidance says the ‘gold standard’ is for a referrer to have a choice discussion with a patient and initiate the referral in the consultation.

It says practices who delegate short-listing to administrative staff must ensure that staff are “adequately trained and have sufficient clinical knowledge of the patient and their condition” to make the referral or short list appropriate services.

Dr Miller added: “I’d like referrers to think again about doing this themselves if they don’t at the moment. It literally takes me between one and two minutes and is by far the quickest way to do it.”

Similarly, the guidance recommends that GPs get a written agreement in place in addition to the standard RA02 form if referral management services are used, covering the circumstances in which the proxy referrer acts, their training and qualifications and who is responsible if a complaint arises.

It says clinical assessment services should bring added clinical benefit for the patient and could be used for Choose and Book, but should not be used as a guise for purely administrative referral management centres.

It also encourages primary care trusts and provider organisations to make sure that computer hardware and software meet the required specifications for optimal Choose and Book usage and that all relevant staff receive regular and appropriate training.

It further addresses slot availability and says hospitals have a contractual obligation to ensure enough slots are available to meet patient demand.

Dr Miller said slot availability issues had fallen from a high earlier in the year of almost 20% to under 12%, but that the goal was for all hospitals to have slot availability issues of less than 4%.

“At the moment it is still more than one in ten patients who are trying to book an appointment and not being able to which is not acceptable. However it is clear that trusts are now starting to proactively manage capacity and demand,” he said.

The guidance is backed by the BMA, which wanted greater clarity on the responsibilities of the NHS and clinicians following its own review of local experience of Choose and Book.

Dr Chaand Nagpaul, the BMA’s GP committee negotiator with responsibility for IT issues, said Choose and Book could be “enormously helpful” to patients and doctors when it works well.

He added: “It is crucial that trusts and PCTs meet the requirements set out in this document so that clinicians are appropriately supported when using Choose and Book.”



Responsibilities and operational requirements for the correct use of Choose and Book