Clinical Informatics

Choose and Book: A critical appraisal of its early development


  1. Introduction and definition of “Booking”

  2. Historical context

  3. Aims and Contents of the Choose and Book project

  4. Key findings of the National Audit Office report: Patient Choice at the Point of GP Referral, Jan 2005

  5. The strength and weakness of the original proposal

  6. Overall appraisal of the project

  7. References

Historical Context

Choose and Book started as the National Booked admissions Programme in 1998 as part of the NHS Modernisation Programme, whose original aim was to make out-patient waiting lists "a thing of the past", by ensuring that all appointments and admissions will be pre-booked in advance. In April 2001, this became a part of the NHS Modernisation Agency with an expressed target of achieving the above by 2005.

The programme was divided into four waves. Wave one began in 1998 and consisted of 24 projects. Wave two started in 1999 and added another 60 sites and focused on extending innovation and best practise. This was followed by wave three in 2000, which was a rapid expansion phase, adding extra 197 sites in total.

The final wave started in 2001 and spread out across England to all health communities. Before its expected completion in 2003, plans were already afoot to incorporate electronic booking in the National Booking Programme in early 2002.

All early waves concentrated on the booking process in secondary care, which mainly dealt with day cases, in-patient appointments and diagnostic tests appointments. However, it was envisaged that in order to achieve 100% booking of all outpatient appointments by 2005, the process would need to be computerised.

Five enterprise communities were subsequently set-up in England in the spring of 2002 to pilot electronic booking from primary to secondary care. These pilots found that patients were very enthusiastic about the process and were more likely to attend their chosen appointments. However, they also learnt that it was critical to fully engage the clinicians and have their full commitment in order for the process to be successful.(2)

Following the above, the National Programme for Information Technology was established in the autumn of 2002. Its mandate was to identify and co-ordinate the key areas of information technology that would be essential for the modernisation of the NHS. Electronic Booking was identified as one of the five key areas that were to be given national priority for further development. The National Booking Programme was now known as the National Booking Team.

Atos Origin was awarded the contract to develop a national application software for electronic booking. They were given 9 months to develop and demonstrate the application in an aggressive management approach with regards to time scale.

By the end of the fourth wave in 2003, the Booking Programme had completed its task and the responsibility for introducing and sustaining new booking systems were handed over to the Strategic Health Authorities. In April 2004, the Modernisation Agency National Booking Team was devolved to the National Programme for Information Technology. In the past 6 years, "Booking" had evolved from a pilot initiative to a mainstream activity throughout the NHS.

Key Milestones

Key milestones achieved during the formative years of the Booking Programme included:

The next stage of the evolution of the Choose and Book project began when the government initiated the Choice Agenda in 2003(3) by commissioning the MORI poll and the Dr Foster study at Nottingham University.(4)

This was then formalised in 2004 by restating the Public Service Agreement of 2002 declaration that:

The "Choice Policy Guidance" was subsequently released in August 2004 followed a few days latter by the "Supporting Choose and Book Delivery Framework" document. The department of health then set forth the detailed plans for implementation in a policy framework known as "Choose and Book – Patient’s choice of Hospital and Booked Appointments" also in August of 2004.(6)

A new post called the "National Implementation Director for Choose and Book" was created in December 2004 to specifically oversee the implementation in the NHS, while the National Programme for Information Technology Programme Director would continue to oversee the technology development and deployment, contract management and patient access nationally.

This added layer of management was intended to provide clear accountability and management support to the national programme.

Finally, in order to facilitate the payment of the chosen provider, payment by results had been put forth as the new financial system for the NHS and will be implemented from April of 2005.


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Page Updated: 17 May, 2017

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