Systems integration

Making Choose and Book work for secondary care

Comment on the Choose and Book system over the last three years has often been made without an understanding of the vision and concepts behind the scenes. Unfortunately, this has served only to complicate, confuse and ultimately switch off the people who would see the most benefit from the system. The reality is that there is a very basic purpose behind Choose and Book: to give patients a choice of the date, time, provider and, yes, where appropriate even the consultant for their treatment; and allow them to book this appointment electronically.

This simple objective was my motivation for accepting the invitation of the Choose and Book team to help develop and improve the system’s Directory of Services (DoS) — the part of the programme that helps ensure patients are directed to the correct specialty or clinic as quickly and efficiently as possible.

As patients are offered a wide choice of hospitals for their treatment, the Directory of Services has a crucial role to play. The fact is that GPs, in the past, knew their local hospital and its Consultant staff reasonably well, but now that the net is spread wider, potentially well outside the GP’s usual area, it has become increasingly difficult for the GP to find the appropriate services.

To help direct referrers to the right service, the Directory of Services uses two filters; a coarse filter, which is the Specialty; and a finer filter, which is the Clinic Type (which is similar to a subspecialty). These do not conform to traditional specialties or subspecialties, but are simply a method of giving the GPs a shortcut to the list of clinics most relevant to their patient.

In addition to these coarse and fine filters there is the facility to search for services using a “keyword or a key phrase”. These are generally descriptors of the patient’s condition or the procedures performed within the service. Typing these in should direct the GP to the most appropriate service.

The Choose and Book team identified that this functionality needed improvement and sought assistance from primary and secondary care clinicians via their respective groups: the National Clinical Reference Panel (NCRP) and the National Specialty Reference Group (NSRG), which I chair.

The initial work conducted by the NSRG was to ask each of the recognised Specialty Associations to help Choose and Book to develop further the initial list of Specialties and Clinic Types within each area. Often this was developed by people who sometimes had a very narrow specialty view and, as a result, the Clinic Types that they prepared tended to reflect the clinic descriptors that they were currently using. Indeed, sometimes these clinic descriptors became so focused as to be unusable.

One example would be the area of sleep studies. There might be a number of different sleep clinics that meant something to the secondary care provider but often eluded the understanding of the primary care referrer. This was one area where the NSRG could bring in its expertise to reshape the Clinic Types so that GPs can now more easily find what they’re looking for.

The issue of patients being referred to the wrong service is a frustrating one for all involved. It happened pre-Choose and Book as well, but now patients have a choice of hospitals we recognise that it has happened a bit more. Clearly as a consultant it is important that the patients who come to you have a condition that you can treat!

It is crucial that consultants take time to sit down with their Choose and Book guides or administrators to map out their clinic type(s), keywords and service descriptions, thus ensuring that the pathway to their clinic is a clear one.

Each trust has appointed Choose and Book administrators (known as Service Definers) and in larger trusts there are administrators for individual specialties. If you have both a clear hospital service descriptor and accurate clinic type(s) on Choose and Book, then you are a long way along the path to receiving only correct referrals into your clinic.

One area of dissatisfaction has been the apparent difficulty in getting a patient to a specific consultant’s clinic. This appeared to be difficult through Choose and Book initially but as the Service Definers get more encouragement from GPs for supporting this, and as the Choose and Book programme becomes more sophisticated, this is gradually improving with the consultants’ details now beginning to appear in the clinic descriptors provided by the secondary care providers.

I believe that we are successfully developing a system that will facilitate appropriate referrals to the appropriate primary as well as secondary care providers. Consultants are now beginning to realise the importance of spending time with their Choose and Book administrator to make sure their information is correct.

A key consideration when working on the Directory of Services has been that a number of the bookings made through Choose and Book are made by members of the GP’s team, rather than by the GP. Therefore, Directory of Service entries must be comprehensible to the average person not just the clinician.

An area where we have had a lot of discussion relates to children and the way that children and adolescents are listed under the specialties and clinic types. Previously these clinics were not listed on the system in a uniform way: some were under paediatrics and some under the parent specialties, such as orthopaedics or ophthalmology. This made it difficult for many primary care providers to be sure where to locate the appropriate services.

As a result, in September 2007 we made the decision to place all children and adolescent care clinics under the specialty descriptor of “children’s and adolescent services”. Initially this caused concern amongst some secondary care providers as they did not want to be perceived as coming “under paediatrics”. However, the reality is that this was simply a method of filtering referrals to enable users to identify the most appropriate clinic as quickly as possible.

Ultimately, I believe that consultant opinion of Choose and Book is changing. There are a large number of satisfied consultants across the country who have realized the benefits of the system and this number is likely to increase. The pace of improvement over the last six months has been significant and future releases of new upgraded versions of the Choose and Book software with its enhanced features, will make a huge difference.

There is a realization amongst both primary care and secondary care clinicians that we need to work together with the programmers and developers of Choose and Book in order for it to succeed. That is now happening.

Professor Angus Wallace, chair of the National Specialty Reference Group (NSRG) and Consultant Orthopaedic Surgeon at Nottingham City Hospital and Queens Medical Centre, Nottingham.