Barking and Dagenham hits C+B high

Dr Ahmed Lawal using Choose and Book

NHS Barking and Dagenham has achieved nearly 100% utilisation of Choose and Book without the use of a referral management service.

The PCT is among the top five trusts in the country for use of the e-booking system and is being used as an exemplar of best practice by NHS IT agency, Connecting for Health.

NHS Outer North East London primary care IT project manager Simon Wheat said Barking and Dagenham practices were making more than 3000 referrals to acute, community and other services every month through Choose and Book.

Barking, Havering and Redbridge University Hospitals NHS Trust had worked with the PCT to go paperless for first outpatient appointments in December last year by making 99% of hospital departments available, he said. Any paper referrals were triaged and sent back to the practice unless the patient was at risk or there was a technical problem.

Maternity services were being piloted with Choose and Book and the PCT was looking at adding community mental health services.

Two-week wait services had also been included in the online booking system and the advice and guidance service - where a GP could directly question a hospital consultant about a case - was being expanded.

Wheat said a large part of the success of the programme was the time spent building relationships and understanding that not every GP practice was the same.

“It’s dealing with practices on a day-to-day basis, trying to help them find solutions and get them to see the benefits and benefits for patients,” he explained.

“There are some things you can do big bang and some things you can’t and when it’s a cultural change, and such a big cultural change, big bang isn’t always the best approach.”

Dr Ahmed Lawal of Becontree Medical Centre said he did almost all his referrals through Choose and Book. The system was particularly useful if a patient wanted to be seen as soon as possible and did not mind travelling, however, most still wanted to go “round the corner”.

“I haven’t had any major issues using the system, it’s reasonably straight forward once you get used to it,” he said.

The service had improved over time with the addition of more information about what services were available, specific details about clinics and any referral or exclusion criteria.

“The reason it works here is that the practice is well organised and certainly the principal is very keen on adopting new and efficient ways of doing things,” said Lawal. The fact many GPs at his practice were “youngish” also helped when trying to get people to change their way of working.

Dr Lawal said having hospital discharge summaries sent electronically through NHS Mail had also made a “really, really big difference” to his work.

Wheat said the consistently high utilisation figures meant he could create Choose and Book reports which were used by practices to monitor referral activity. These reports could also be used by emerging CCGs to see any trends or gaps in service provision.

Stephen Miller, National Medical Director for Choose and Book, said Barking and Dagenham’s result was a “great achievement” and “demonstrates how when providers and referrers work together they can significantly improve clinical practice and provide better patient care and experience”.

“In this case, the large providers have worked really hard to make all their services available on Choose and Book and GPs across the local health economy are fully engaged,” said Miller.

“Now, clinicians can genuinely ask themselves why they wouldn't use Choose and Book for all their referrals.”