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Study finds patients not getting full Choose and Book benefits

5 August 2008

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The government’s flagship Choose and Book scheme is failing to offer two-thirds of patients the choice of appointments it was designed to achieve, a study has found.

According to research by University College London (UCL), 66% of those surveyed said they had not been given any options of time or date when using the NHS’s new computerised booking system.

The research also found that 86% of people were offered a choice of fewer than four hospitals, while 32% were offered no choice at all.

Just a single patient said that they had been given a choice of four hospitals, appointment date and time – which the GP surgery, online and phone-based system was designed to offer everyone.

The majority of respondents (63%) had been unaware before their GP appointment that they could choose which hospital they were referred to.

Of the patients who had booked through their GP surgeries, less choice appeared to be on offer than for those who had booked online. However, technical problems with the online booking system were reported.

Dr Henry Potts, UCL Centre for Health Informatics and Multiprofessional Education, who ran the study, said: “It is striking that nobody, up until to this point, has actually asked patients about their experience of the system.

“These results show the reality of what’s happening on the ground, surely vital when it comes to measuring to what extent this is working or not.

“This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”

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An NHS Connecting for Health spokesman said:

“From 1 April this year, patients have had even greater control over when and where they can get their treatment. Any patient receiving routine elective treatment is now be able to choose from any NHS approved hospital provider in England.

“As part of this, the electronic referral system, Choose and Book, allows patients to choose their outpatient appointment according to their own priorities – whether that is the first available date, the hospital closest to their home, or fitting their appointment around their family or work commitments.

“Today, Choose and Book has had more than 10 million bookings and the University College London (UCL) study of 104 patients from a single hospital, two years ago, does not reflect the experience of most users.

“Recent major surveys on patient choice and primary care consistently show the number of patients using Choose and Book and being offered a service continues to steadily increase.

“Choose and Book is used for around 50% of all GP referrals to first outpatient appointment. 98% of GP practices have Choose and Book and currently 92% are using it for referrals.”

Your comments: (Terms and conditions apply)

“No, not from the patient’s perspective – if you do not accept the appointment offered and ask for a slightly later date you are told that you have to go back to your GP to be re-referred!! There is no patient choice” – Name and address withheld

“No appointments available at the hospital of choice – worry that 18 weeks’ wait will not be met. Some appointments are given then rejected, only for patients to be listed again!” – Elaine, Manchester

“I believe that the the Choose and Book system is being used widely in Wirral. With regard to Dr Potts’ comment that nobody has been asked about their experience, an annual survey is carried out in support of the Access DES” – Allan Stewart, Wirral

“In part; since all the information is not available, the system is
inherently slow and some patients are unaware of the choice they have, it’s unlikely to be working properly. The major disadvantage is that the GP referring is unlikely to know much about the consultants outside their usual area of work, thereby limiting the choice to whatever the patients can find out for themselves. It does however, appear to reduce the DNA rate as those with no intention of attending no longer ignore their appointment – they just don’t bother to book” – Name and address withheld

“In practice it does not deliver what the patient expects. Patients often have to leave the practice without a booked appointment because hospitals do not provide appointments “Directly Bookable” (although they say they do). Also some consultants refuse to use CAB; their referrals are stored and when they have enough for a clinic the patient is sent an appointment …no Choose and Book at all. All my staff find the whole system frustrating … it is used as a tool to the 18-week  wait and has little or no value in the choice of the patient” – David Rose, Staffordshire