GPs will have to use Choose and Book or face “potentially labour intensive methods” for booking appointments under new plans outlined by the Department of Health.
A new consultation paper - Liberating the NHS: No decision about me, without me - says the DH is also looking at developing the e-booking system and NHS Choices so that patients can book directly through C&B.
The document says the DH is “working to maximise use of Choose and Book so that more referrals are made through it and more patients are given an opportunity to make choices over their care and treatment.”
“Where Choose and Book is not being used, formal requirements to support greater choice for patients will have to be met by alternative, potentially labour intensive, methods,” it says.
EHealth Insider reported in March that C&B usage had fallen from a high of 57% to just 50%.
The paper says data showing utilisation rates by practice for the e- booking system will be published online. This will allow patients and the local public to “exert pressure” in areas where C&B usage needs to be increased.
Hampshire GP Dr Neil Bhatia described the plan as a “sad and somewhat desperate” attempt by government to ramp up usage of C&B.
“It speaks volumes when you have to make threats for people to use software,” he said. “If people aren’t using it, it is because they don’t want to, or it’s not very good.”
Dr Bhatia said the “labour intensive methods” referred to would just be a continuation of what practices already do – in other words, faxing, emailing and posting documentation.
“These are all hollow threats that the DH hopes will make a few practices say ‘ok let’s do it then’, and figures will go up.
“But the figures have stagnated because those who want to use it are using it and the rest don’t have an interest in it,” he argued.
Dr Bhatia tried using C&B some years ago and found it “dreadfully time consuming.”
He said it was impossible to fit using the service into a ten minute appointment and that it prompted many complaints from patients who were unable to book appointments.
The idea that practices would have to ring around a lot of hospitals to find an appointment was also unlikely because “very few” patients want to exercise choice and are happy to take the advice of their doctor, Dr Bhatia added.
Under the new standard contract set out in the consultation paper, providers would be required to: list all services eligible for patient choice on C&B; accept all clinically appropriate referrals made through C&B; publish information needed to support these choices; and work with commissioners to “ensure that service users are not delayed or inconvenienced by insufficient appointment slots being made available to Choose and Book.”
The consultation paper says that diagnostic tests which are not carried out as part of a consultant-led first outpatient appointment should be listed on C&B and be directly bookable by patients, provided this is clinically appropriate.
The requirement to provide direct access to diagnostic tests will be set out in standard contracts. Over the coming year, the DH will set out which tests will be the priorities for inclusion on the system from April 2013.
These could include high volume services such as audiology, non-obstetric ultrasound, gastroscopy and electrocardiograms.
All direct access urgent referrals, such as cancer two week waits, will be exempt, but providers could continue to use C&B to list these services and allow direct bookings to them, the paper says.
Commissioners would be required to ensure that this choice is available to all eligible patients. The document adds that a key obstacle to using the electronic system for booking diagnostic imaging services is the incompatibility of the existing radiology information systems with C&B.
“Work is ongoing to identify how best to improve the compatibility of the systems with a view to including imaging services on Choose and Book,” it adds.
As part of its exclusive survey of CCG IT and information plans, EHI Primary Care asked GPs and emerging CCG leaders about their plans to use national services like Choose and Book in the future. Read more about the survey on EHI Primary Care.
© 2012 EHealth Media.
C&B works a dreamRichard Sarson 122 weeks ago
For the first time in four years I have used C&B. It worked a dream, with no time wasted by my GP. The moral for GPs is that, as with any software innovation, if you work to make use of it, - integrating it with your EPR, and persuading your local hospital to do the same, - it can be a great time-saver. If you don't bovver to think how it will help, it won't. Whether GPs love it or hate it says more about them than the system itself as it has evolved over the years.
One instance out of how many?CanUseeTheLight 122 weeks ago
Great to hear of the success, however what was teh actual cost of that time saving for that appointment?
Once booked thereafter the Trusts outpatient systems take over, so what has in reality been gained?
C&B will only display slots which are publised. As I have said in the past Trusts elect not to describe outpatient services as such and therfore their slots never appear on C&B thus reducing the 'Choose' in C&B.
Wehn it first went live and CfH publised its first set of data each 1st appointmet was costing the tax payer over £64,000 to book.
I am still waiting to see what each 1st appointment costs today and although I dont think it will be that high teh actual cost will still be massive compared to the perceived or actual benefit.
I guess thats a good deal for the moral of a GP.
Follow the white Rabbitin arduis fidelis 97 weeks ago
suggest you look at this link.............and see more than one instance, now spreading outwards. Happy to explain how it was done (not a LES payment in sight either)
Electronic systems are no good if not backed up with actual appointments!Manager59 123 weeks ago
In our area it is pointless using C&B because there are hardly any appointments available. A complete waste of time for ourselves and the patients. Cumbersome, stupid and useless - SCRAP IT!
Scrap it and stop spending good money after bad.CanUseeTheLight 123 weeks ago
I cant remember the number of posts I have made about C&B. Fundamentally flawed system in oh so many ways. Anyone who has read the requirements documentation and Message Implementation Manuals (multiple versions) could not fail to recognise the train wreck approaching. I attended workshops in Leeds back in 2003/4 run by CfH where it was very clear that this was being built on the fly with goal posts moving on a release by release basis. Both it and the SPINE were not even NHS data dictionary compliant (this would seem t be the most basic standard one would need to adhere to). Moreover, the model being applied, one size fits all, was also never going to work as not all appointments are managed in the same way. The system SPINE and C&B make secondary systems slaves to the master central record leading to patients which cant be discharged from PAS/EPR systems and requiring Trusts to generate their central returns via some other route. If you work out how much has been spent to date on SPINE and C&B (you need both) and divide by the number of first appointments actually attended, C&B only books the 1st appointment the cost per appointment is huge. The money has been wasted pure and simple. I could go on and on and site explicit examples of Trusts %u218no longer providing outpatient services%u219 just so they don%u219t have to use C&B, but I would probably be censored. If the C&B scab was independently picked a festering wound would be uncovered.
Designed by people that simply don't get it!dmloclam 124 weeks ago
The road to hell is paved with good intentions.
As a patient, I am thrilled at the prospect of being told by my GP that I need to see a consultant and to immediately be given the opportunity to arrange this appointment on a date and at a time that suits me. That's the wonderful image.
Now for the reality!
A GP is contracted to provide a minimum number of appointments per week. A GP is required to offer ten-minute minimum duration for at least 70% of these appointments. It is almost certain that the time taken to arrive at the referral decision will have used up most of these ten minutes. Therefore there is no time left for the GP to enter into a protracted negotiation with the patient about which hospital, day, and time they would prefer. This is a fundemental problem that continues to be ignored as "an inconvenient truth".
The taxpayer does not pay GPs the sorts of money they earn to become "medical travel agents"; a job that can be done by a skilled receptionist but for whom there is no funding.
Right back when C&B was first introduced, I finally got the GP lead to admit that there had been no testing whatsoever of the transaction time for completing a C&B referral. These times are made longer by the appalling design of the user interface.
Despite this, C&B has been pushed relentlessly not least because it could then be claimed as a success of NPfIT/CfH whilst the rest of the programme collapsed in a fog of financial and project management ineptitude.
Next it will be EPS2 with all the same bullying tactics.
Designed by people who simply dont get itlozzer 123 weeks ago
This type of comment makes me laugh. So 50% of GP's are successfully using Choose and Book and 50% are not. I wonder if this is a capability issue, I believe it is. When the current over 4 year old GP's have all reached 55 and taken their final salary pensions and the new younger generation are in situ, I am sure we will see technology flying through the NHS as they will demand it and I for one cannot wait. Lets face it, you guys just dont like being told what to do and want it all your own way. Choose and Book is a very simplistic booking system, not in the least complicated and yet, even something this simple seems to baffle a lot of you....move aside and let the children through to show you how its done.
Yoda reality check is necessaryCanUseeTheLight 123 weeks ago
Simple not it is?
Expensive it is?
Time save it does not.
Cheaper than an a FAX or stamp it isnt.
of the 50% who apparently use it how many actual appointments are booked through it and are attended maybe good to ask.
lozzer, have you ever tried to use it?Mary Hawking 123 weeks ago
Like most of my generation - over 55.. - I use on-line booking, banking and other services with no problems at all.
If you think the problem is with GP resistance on a technophobe issue, why not look at how C&B actually works in practice - both at the booking end (GPs) *and* the receiving end (hospitals operating C&B booking)?
On the whole, if a system works it will be adopted : if 50% of GPs are refusing to use it, have you considered that they probably have excellent reasons for this?
Ageist assumptionGeepsi 123 weeks ago
Lozzer; What makes you assume that it is the older users that are ignoring C&B?
In my practice, the 'young' GPs are less keen than the older ones, precisely because they cannot be bothered with the slow, clunky, non-intuitive interface on top of an impenetrable directory of services and, as others have said, not in keeping with the real processes of primary and secondary care interaction.
Your ageist assumption also ignores the fact that the 50+ GPs are the ones that got GP computing going in the 80s and 90s and many of the most enthusiastic members in the user groups are in this age group. We are the generation that grew up with the original home PCs and learned how to programme, not just use computers.
It is far from the case that our eventual retirement will bring in a golden age as many of the younger doctors have poorer IT skills as they are primarily users rather than designers and influencers of systems.
who and where are they now?morefedup 124 weeks ago
"I finally got the GP lead to admit that there had been no testing whatsoever of the transaction time for completing a C&B referral."
If this is true - just hope that whoever that was isn't in charge of anything else of consequence - total ruddy disgrace - are these people ever held to account?
CaB Usage/EfficiencyTonyK 124 weeks ago
It is very clear that this particular GP has not had the support rfequired in order to ensure that his/her practices use of Choose and Book process is as efficient and effective as it could be. This is a problem across the country. CaB "does what it says on the tin". The eareas that need attention are the areas that support Choose and Book. Such as Hardware/electronic referral templates/review of the business model in use at the particular practice for Choose and Book. All of these areas, looked at objectively and openly, WILL improve the perception and use of Choose and Book across the country.
This is from an experienced interim Choose and Book Project Manager.
look up from your screenPaul Cundy 122 weeks ago
The experienced C&B project manager would benefit from standing back a bit from his/her screen and looking at the bigger picture. Use this thread as an indicator, the vast majority are explaining detailed and established problems and many are clearly saying they'd like to be able to use it.
Perhaps you should start at the beginning; "C&B "does what it says on the tin" ".
Err no it doesn't. Your booking is not garuanteed and you have no idea whether you've been offered real choice.
If you started from that premise and tried to work with the users you might find uptake would improve.
It's a system, not a piece of softwaredmloclam 124 weeks ago
"C&B does what it says on the tin"
C&B is a software-based system. The software may do what it says but the system is incomplete and poorly administered. This is because the costs of the day-to-day management of the system were never funded. Thus we are in the insane position of GPs being asked to travel to the other end of the patch to renew their smart cards because there is no funding for this fundemental component of C&B et al.
If the true costs of the day-to-day running of these systems were properly assessed a couple of parliamentary select committees wouldn't give CfH the easy ride they currently enjoy!
AbsolutelyNeilB 124 weeks ago
I could not agree more.
EPS2 will be a similar disaster, years behind schedule.
Where I am, we have stopped using EPS1 (the "barcode" on the FP10).
What's the point, when none of our local pharmacies scan the barcode?
It's also much quicker to issue prescription without the smartcard.
Its Just doesn't work..NHSCIO 124 weeks ago
Its not just about primary care ! C&B is as unwieldy in secondary care also.
There is no real integration with Trusts PAS systems, referral letters remains locked in C&B unless printed out (probably to be re-scanned). Trusts need to run multiple referral systems C&B, paper, FAX, eMail which just adds cost to the organisation. C&B being probably the most costly to deal with in terms of staff time.
Its a political tool, not intended to improve the referral/booking process and is now so dated... The NHS has moved on from this very blunt and basic service.
Basic failure of business analysis?mrtablet 124 weeks ago
1. The request for the opinion of a (sometimes) named professional is not the same transaction as "booking an appointment"
2. NHS out-patient appointments are not analagous to on-line cinema, airline etc because
a. the sooner tickets "sell out" the better
b. it doesn't "matter" if tickets sell out - no contigency slots need to be held back
c. the person making the booking knows their precise requirements. (I know I want Economy Class London to Dublin - the GP doesn't know whether the patient needs a 15, 30 or 45 minute slot etc.)
IMO no amount of user interface tweaking or software mediated gerrymandering behind the scenes can square this circle.
C&B needs pull, not pushGuildfoss 124 weeks ago
C&B was a great idea 10 years ago before services like meetup, eventbright, doodle, yammer etc became commonplace. Now it is bit old hat, as any service which is essentially B2B(business to business) relies on third parties for success, and third parties can be quirky. For C&B to succeed it need to act on UK hospitals behalf and serve up the C&B clinic data to the wider IT market, or better still, get the solution delivered at the next #NHSHACKDAY
Imaging on C&BGavin Jamie 124 weeks ago
Locally we can request imaging on and ICE based system. It is used because it is well integrated into our clinical system. It is quick, relevant and works well.
We are not paid or forced to use the system but do so because it is highly effective.
C&B is none of these things. We stopped using it after getting fed up of dealing with complaints about it. Some of our staff were actually threatened by a patient who was under the impression that we had some control over the cancelation of his appointment.
Any move to C&B needs a corresponding move to Choose and Book 2 - learning the lessons from version one.
PreciselyPaul Cundy 124 weeks ago
Yes and we have been using pathology requesting using Dart Com. Its brilliant, simple, well integrated and fast enough to use during the consultation. Not paid to use it. Its been so good we asked (and got) it to be extended so we now use it for imaging - all types and histology, microbiology etc. Excellent all round and real David against C&B's goliath. If it works we'll use it.
what's more labour intensive.Paul Cundy 124 weeks ago
As you can imagine I welcome teh concept of e-booking. However my and my patients experience of C&B is that it is the most labour intensive process by far. Like Dr Bhatia I have given up using it because it is not fit for purpose.
Additionaly it is a fraud because not all appointments available are on it, the trusts control (manage) what they make available on it, and finally quite often the appointments are virtual, once teh patient is accepted they are then contacted and asked to move to a real appointment.
So sad and should be dealt with appropriatelyGlen Griffiths 124 weeks ago
Paul - I picked up on your point about possible gaming of the C&B system when the story around decreased usage of C&B emerged on EHI during March, I know that accusation isn't new. I don't use the system so can't corroborate but do have relatives who have been messed about with booking, cancelling, re-booking cancelling, re-booking and so on. If indeed it is the case that some trusts are playing the game and offering non-existent slots in order to drum up (or secure business) then this surely is a huge betrayal of trust to the very patients (not underestimating impact on doctors and practice staff) that C&B was intended to serve. Is anyone aware of any censure given to trusts for this alleged highly dubious practice. Airlines regularly make more seats available than are actually on the plane on the basis that people don't show up or can be tempted with a night in a hotel and a few drinks if more show up than can fit on the plane. Airlines call this yield management - if this is going on in the C&B arena what do hospitals and other providers call it I wonder?
Central micromanagement by another name?Mary Hawking 124 weeks ago
If this represents devolving power to local control...what does central direction look like?
Choice of hospital and consultant was abolished by Kenneth Clarke in 1990 ("the money follows the patient" = "the patient follows the money") : the doctrine of "choice" has restored - to some extent - choice of hospital but *not* - most emphatically not - choice of consultant.
C&B is used by practices - usually not during consultation (most patients don't bring their - and their family's - diaries to a GP appointment) - *where the system is working at the hospital end*: I have heard rumours that such hospital C&B systems do exist: no personal experience.
Without the top-down micromanagement Andrew Lansley claims to be abolishing, it is hard to see how he intends to enforce this. The time element makes carrots - and sticks - almost irrelevant., especially as the diktats will change next week - or month - or year - or Secretary of State for Health - and certainly after the next election! ;-<
Investigations are just that: investigations. CfH has never insisted on the central database store of images envisaged under PACS; the suspicion is no-one had considered the bandwidth and cost of storage involved, let alone the practical implications.
How will it help the patient to have an investigation in a super-market carpark, which will only need to be redone later?
And all of this to be mandated by Andrew Lansley for reasons which appear to be related to an ideology of doubtful validity in the real world - and removing almost all control from CCGs!
You couldn't make it up, could you?