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

Strengths and Weaknesses

The strengths of the project are:

  1. A very aggressive time scale with a front-loaded implementation approach, which aimed to improved the speed of delivery of the targets.

  2. Clearly defined time scales and targets

  3. Clearly defined responsibilities

  4. Identification of specific areas of information required to support patient choice

  5. Clearly defined local implementation plans

  6. Procurement on a national level, which aimed to exploit the economics of scale and derived significant savings from that

  7. Insisting on Proof of Solution before payment of contract in order to minimise the risks of procurement

  8. Centrally driven implementation of a large part of the project via the creation of NPfIT

  9. Identifying and assigning ownership of strategic risks of the project

  10. The use of pilot sites to test solutions and redefine expectations

The weaknesses of the project are:

  1. Over-ambitious timescale in-view of scale of project and the organisational change and complexities involved

  2. The apparent lack of prioritisation on the part of NPfIT in terms of the order of development of the key IT projects. Software applications cannot be implemented without the availability of the secured national network first or integration with pre-existing systems

  3. Decision not to engage and consult the clinicians early in a project that directly affects their workflow and patient care, does not encourage buy-in and may lead to project failure

  4. The selective use of a single telephone survey of 92 patients who have recently used the National Waiting List Helpline to justify the agenda of choice on behalf of patients and doctors is misleading

  5. Strategic benefits are only assumed or based on anecdotal evidence from pilot studies

  6. The decision to include private institutions as part of choice was made without any effort to study itÂ’s impact on local health services

  7. The decision to implement payment by results was also made without any effort to study the possible implications for local health services, which may be deprived of funding and may lead to the closure of these services

  8. It is not clear how the private institutions will connect to the NHS spine and access patient data. What are the issues as regards patient confidentiality and security? It is also not clear whether they will provide the same kind of information that would be comparable with the NHS Hospitals in order to allow informed choice for the patients


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Page Updated: 17 May, 2017

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