Serving North & West Yorkshire

"Choose & Book
(A system to enable patient choice)"

Tuesday 6th December 2005, 1830

Speaker: Alexandra Morton-Roberts
[North & East Yorkshire & Nothern Lincolnshire Strategic Health Authority]
Venue: Hotel Metropole, Leeds.

A copy of the presentation is available for download. As it was quite large (4Mb) it has been converted to a pdf and "zipped" (to just under 2Mb). Download the presentation

Choose and Book – a System to Enable Patient Choice
Alex Morton-Roberts Head of Service Improvement, North & East Yorkshire & Northern Lincolnshire Strategic Health Authority
6th December 2005

We had a very interesting evening with Alex’s talk being well-structured and full of information. She is the lead for Choose and Book and is supported by colleagues in the National Programme for IT (NPfIT).

Alex started her talk by outlining the aims and objectives of Choose and Book (CAB) and where it fits in to the NPfIT. To put everything in context, this Strategic Health Authority (SHA) is diverse covering 4500 square miles, 1.64 million people and there are 9 Primary Care Trusts (PCTs) using CAB and 16 NHS organisations involved. The SHA adopted a programme structure for CAB which was aligned to the planned care board. There was a CAB subgroup and each PCT has a CAB project which links into the programme.

What is Choose and Book? From 1/1/2006 all patients should be offered the choice of at least four providers of secondary care when referred from general medical or general dental practice. Also they should have the opportunity to prebook their outpatient appointments. CAB is one way of enabling this. The choice of place and date for the appointment can be achieved in various ways. The technical architecture is fairly complex. The GP system can be either a local system integrated with CAB or a local system using web access to CAB or a centrally hosted system. In the middle is the CAB system. The hospital will provide services which may be directly bookable or indirectly bookable. The interconnections are made via NHSNet or N3 with routers and firewalls in place at each interface. Security is good making this is significantly safer than, for example, internet banking.

When the patient sees a GP and it is decided to refer, the GP may use CAB. Choice of place and service is available based upon information provided about the services by the consultants. The patient is given a unique booking reference number (UBRN) which is unique to that patient and that referral. There are then several ways in which the first appointment can be made, at a date & time suitable for the patient. The information about services can help the GP e.g. by advising of tests needed before the referral itself. Also they can use this system to obtain advice about the care of the patient. The administrative staff at the practice will attach the referral letter to the booking. This eliminates lost referral letters.

At the hospital, the administrative staff will print the referral for the consultant and then accept, amend or reject it on his/her behalf. If rejected then it is returned (electronically) to the GP. Because of the booking guidance there should be fewer inappropriate referrals and as the patient makes the appointment there should be a reduction in the number of missed appointments.

Having given us the background, Alex went on to outline two case studies. Craven Harrogate and Rural District PCT. There are 26 practices and the main providers are Harrogate, Airedale and Bradford. This pilot is one of eight early adopters in 2004 and involved six practices. From 2/2004 to 12/2004 they worked on business processes and changes, identified resources needed, developed close working relationships with practice managers and hospital staff. There were complex technical and business changes. In 2/2005 the extended roll out began. A phone line was set up to provide choice to support GPs and patients. There was closer working between primary and secondary care. One of the advantages of being first was the alignment of CAB to their business processes. 50% of Harrogate practices are now live with 717 referrals made via CAB (to 1/12/2005). Most GPs are fairly positive, consultants have taken an active interest and there has been positive feedback from patients. Initially the pilot only did the “Book” but has now moved onto the “Choose” part as well. There have been unforeseen issues e.g. can the local infrastructure support the systems? With rapid development of the system in response to feedback it has been hard to keep up with training and dissemination of information.

Northern Lincolnshire Local Health Community (North Lincolnshire PCT & North East Lincolnshire PCT) with 55 practices and 3 main providers. The business changes had been identified and primary and secondary care were used to working together. However, there was a lot of work needed on the technical infrastructure. For example it could take up to 30 minutes to log onto CAB, the networks couldn’t handle the increase in traffic and the proxy and mail servers had not been optimised.

To overcome these problems they made full use of N3, giving increased bandwidth, scaling and setting up new WAN. They also used Active Directory and MS Exchange 2003, giving faster email. This has increased speed so that the entire CAB process now only taking 1.5 minutes. Before the changes the net bandwidth available to the sites (120 of them) was 256kbps. Now each GP site has 1Mb DSL link to the hub sites where there is up to 100Mbps. Things outside CAB are also faster e.g. recording assessments, emails so other health workers are benefiting. The roll out across the 120 sites will have been done in 6 weeks. It is estimated that by the end of December about 60% of referrals will be via CAB and that by the end of January 2006 all GPs will have access to offer choice of provider and date/time.

Top tips are:
• Communication is vital
• Make sure systems are robust
• Involve clinicians at every step
• Don’t underestimate the task
• Expect the unexpected

We then proceeded to questions from the floor, a few of which are summarised:
Is there a safety net in case the patient doesn’t book? Yes – there is a GP work list which shows things like this.
If you book an appointment then discover that it’s not convenient can it be changed? Yes via phone or the web. An appointment can be changed more than once.
What happens if the patient wants to think about their choices? They are given the UBRN which they can follow up later.
How does the patient “prove” who he/she is when doing this? The system auto generates a password and the combination of UBRN and password is needed.
Are there any plans to expand the booking to repeat appointments? Not in scope at the moment.
Are there any national guidelines regarding courtesy to patients in written communication from hospital? There are some suggested templates with wording but each hospital can decide.

(You can view Alex’s presentation using the link above.)

Margaret Moore

"Choose & Book (A system to enable patient choice)"

"Choose & Book
(A system to enable patient choice)"