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

Project Contents


Towards the end of 2004, the Choice agenda had clearly taken over the National Booking Project. This was clearly stated as "Choice at referral: The NHS Vision". The expressed targets were that by December 2005, all patients referred for elective care can expect to have:

  • A choice of 4 to 5 service providers

  • Booked appointments with the preferred provider during the consultation, or 24 hours within of the decision to refer or admit

  • Information to inform choice

  • Their GP or a primary care professional for support in making their choice, along with any other packages that might be necessary to ensure that all communities will benefit from choice

  • Aftercare and rehabilitation to be provided locally

Core Components

The core components of the project consist of:

  • The National Booking Application

  • The Directory of Services and Appointments

  • Booking Management services

  • The supporting Infrastructure and software applications

  • The implementation of the above by the Primary Care Trusts organisation

The National Booking Application contract had been awarded to Atos Origin in September 2003 and the application delivered in June of 2004. From July of 2004, this system had been fully functional.

However, there have been repeated delays in its implementation and integration with pre-existing GP systems. This was mainly due to the inability to reach an agreement with EMIS, which provides over 55% of the GP systems in England. This has just been resolved in March of 2005.

Atos Origin will also develop a stand-alone version of the software for demonstration as part of the plan to engage the clinicians. However, there has also been delays with this and is not expected to be ready before Jan 2005.

The Directory of Services and Appointments are to be maintained by the PCTs but populated by the Acute Hospital Trusts and will be presented to the patient as a set of menu as part of the booking process during the consultation with the GP. . These services are to be commissioned by the PCTs after consultations through local patient forums and discussions with Local Authority Overview committees as well as the local Scrutiny committees. They can be from a variety of sources such as:

  • NHS Trusts Hospital

  • Foundation Trusts Hospitals

  • Treatment Centres(Private or Public)

  • Private Hospitals

  • GPs with special interests

  • Others (Dentistry, etc)

From 2008 onwards, there will be no limits to the number of providers that the patient can choose from under the " Free Choice" policy. These providers can either be from the public or private sector.

The only exceptions to the choice policy are when the speed of referral is essential, such as emergency admissions, chest pain rapid access clinics and cancer services.

The Booking Management Services will be providing Call Centre services to support the booking process. This will allow the clinicians or patients to modify any pre-existing booking that has been made through the electronic booking service without having to go through the whole process again. It is not intended to work as an alternative route of booking but to provide administrative support during the early phases of electronic booking only.

It is expected that eventually, the electronic booking application will be integrated with the electronic care record service that is currently being developed by NPfIT. There would also be a need for a National Spine to connect all the GP practices and Hospitals together. This spine is currently being deployed by British Telecom and is known as the New National Network.

This is expected to be complete nationally by 2006 but priority is being given to connect the early adopters of the electronic booking scheme. In addition, there needs to be a national security register that will be responsible for issuing the smart cards and passwords that would be essential to the security and confidentiality of the system. 

The Responsibilities of the Primary Care Trusts

The PCTs have been given the responsibility of ensuring the implementation of the above as part of the "Shifting the balance of Power" policy by the Department of Health. They are supported by the NPfIT in three key areas:

1. General assistance

  • Programme Management

  • System Assurance

  • Communications

  • User training

2. Technology

  • Implementation of the national network

  • Provision of the Choose and Book Software

  • Testing and integration of viable legacy systems

  • Registration Authority Toolkit for issuing smartcards and passwords

  • Smartcards and readers

3. Finance

  • National funding for the project

The PCTs is thus responsible for ensuring the availability of choice and making sure that the necessary systems and processes are in place to support choice and booking. The secondary care Trusts are responsible for honouring the bookings and develop clinical governance, handover and service provisions to allow a minimal of bookings 6 weeks in advance.

The projected benefits were:

1. For the patients

  • More personalised service
  • More convenience and certainty
  • Choice of time and place
  • Opportunity to discuss treatment plans with the GP

2. NHS

  • Primary care

    • Reduced patient enquiries
    • Reduced bureaucracy
    • Reduced paperwork

  • Secondary care

    • Reduced rate of "Did Not Attend"
    • Reduced administration work
    • Provide an audit trail of referrals
    • Provide an opportunity to standardise referrals

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Page Updated: 17 May, 2017

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