Choose & Book (A System to Enable Patient Choice)

Tuesday 6 December 2005

Alex Morton-Roberts of North & East Yorkshire & Northern Lincolnshire Strategic Health Authority


We had a very interesting evening with Alex’s talk being well-structured and full of information. Alex started her talk by outlining the aims and objectives of Choose and Book (CAB) and where it fits in to the National Programme for IT (NPfIT).

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 with a CAB subgroup and each PCT has a CAB project which links into the programme.

What is Choose and Book? CAB is one way of offering patients choice of secondary care (when referred by a GP) and the opportunity to pre-book their first outpatient appointment. 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 significantly safer than, for example, internet banking.

When it is decided to refer a patient, the GP may use CAB. The patient is given a reference number (UBRN) which is unique to that patient and that referral. There are several ways in which the first appointment can be made. 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. 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; 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. 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.

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 so other health workers are benefiting. 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.

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 that 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.
  • 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.

View the presentation (PDF)