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

Key Findings of NAO Report Jan 2005

The National Audit Office is an independent entity whose role is to scrutinise public spending, to ensure that public resources are used effectively and efficiently. It has the mandate to act on behalf of Parliament and reports directly to the Parliament.

The findings of the NAO report on January 2005 entitled "Patient Choice at the point of GP Referral" are:

  1. Choice is intended to deliver benefits to the patients

  2. Choice is affordable and should benefit the NHS

  3. Other reforms are needed to enable Choice to deliver patient-focused care

    1. Provision of supporting IT systems

    2. Cultural, organisational and behavioural changes

  4. Progress has been made to delivering choice at point of referral

    1. Infrastructure implementation (e.g. New National Network, Local Service Providers)

    2. NPfIT

  5. Key Challenge to roll-out of choice is clinical engagement

    1. Choice will not be delivered without GP support

    2. Choice is best delivered via electronic booking, but electronic booking will not be universally available by December 2005

    3. Part of the NHS still have a lot to do in order to deliver choice as around 30% are not planning to meet the targets

  6. PCTs struggling

    1. 25% not planning to deliver Choice targets

    2. 66% still in the process of identifying and commissioning the number of providers required

The report feels that there are sufficient evidence to support the idea that provisions of Choice will improve patient care and satisfaction.

Due to the expected increased in organisational efficiency and reduced administrative work, the report expects significant savings from annual operational cost which would offset the costs of implementing Choice and make it affordable. It has noted the support provided by the NPfIT organisation in terms of infrastructure, Technology and funding.

The report is realistic and does not expect the universal availability of Choice by December 2005 and has suggested alternative interim options. Choose and Book has only registered 63 bookings with the system form July 2004 to December 2004 out of an expected 205,000 bookings.

Only 70% of the Patient Administration System in hospitals are expected to be compliant by December 2005, while only 32 GP practices (out of a total of 10, 683 in Jun 2004) have been connected to the spine by March 2005.

However, it has emphasised that these temporary solutions (such as the Booking Management Services, Web based booking, Indirectly Bookable Service) should not detract effort and funding from the ultimate aim of 100% electronic booking at the point of GP referral.

The other risks with using interim solutions are that they might lead to more confusion and set back clinical engagement with the clinicians.

Risks Identified by the NAO

It has also identified that failure to engage the clinicians in general and GPs specifically would pose a major risk to the project. It has recognised the fact that at least 61% of GPs felt negative about the initiative. Their main concerns were that:

More worrying was the findings that in the NAO survey of 1500 GPs, 92% felt that they were not consulted in the development of the project, 94% knew little of how Choice will be delivered in practise and 97% had no idea of what the time table involved in the delivery of Choice.(7)

It has stated that the Department of Health’s policy not to engage the clinicians until a fully functional system is available is risky and may lead to the formation of more mistrust and resistance the longer the delay.

It has also acknowledged that the PCTs are struggling with their new roles and responsibilities. They have to adapt to the new concept of "Flexible Capacity" in order to provide choice in addition to the other service redesigns required.(8)


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Page Updated: 17 May, 2017

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