Choose and Book Fails to Deliver Choice For Patients

Dr Henry Potts from CHIME just emailed me about an interesting new paper he has co-authored:

UCL Press Release



Choose and Book failing to deliver choice for patients


Patients are not experiencing the promised level of choice in appointment times, dates and locations promised by the introduction of the NHS’ new computerised booking system, according to the first study of patients’ experience of Choose and Book led by researchers at UCL (University College London). The study is published today in the journal BMC Medical Informatics and Decision Making.


In a survey of patients who had used the Choose and Book system for referral to a large London hospital, 66 per cent said they were not given a choice of date for their outpatient appointment, 66 per cent said they were not given a choice of appointment time, 86 per cent reported being given a choice of fewer than four hospitals and 32 per cent reported not being given any choice of hospital. Overall, only one patient reported that they had been offered a choice of four hospitals, appointment date and time – the level of choice Choose and Book was designed to offer everyone.


Choose and Book is the central component of the UK government’s patient choice agenda and seeks to provide patients with choices regarding the time, date and place of their first outpatient appointment via a computerised booking system. Patients can either choose their initial hospital appointment while they are at their GP surgery or book over the phone or via the internet at a time that is more convenient to them. The system was launched in January 2006.


Dr Henry Potts, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), who oversaw the study, said: “It is clear from these results that these patients were not experiencing the degree of choice that Choose and Book was designed to deliver. This may be only one hospital, with results taken in a transitional period, but we believe this could be typical of the national picture.


“Patient choice has been heralded as the driver for transforming the NHS and a means of meeting the expectations of patients. It is cited as the solution to much that is presently wrong with the NHS – from excessive waiting times to even car parking issues.


“It is striking that nobody, up until to this point, has actually asked patients about their experience of the system. These results show the reality of what’s happening on the ground, surely vital when it comes to measuring to what extent this is working or not. This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”


The study data also reveals that 63 per cent of patients had not been aware before their GP appointment that they were entitled to choose to which hospital they were referred. Those who had booked through their GP surgeries appeared to experience less choice than those who had booked online, but patients who had used online booking reported some technical problems.


In comparison with patients using the old booking system, patients using Choose and Book did report being offered a greater choice of hospital. However, they did not report being offered a choice of time and date any more frequently than those who had used the old system.


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