Choose and Book

Choose and Book (also known as CaB or C&B), is the name of an E-Booking software application which is being introduced to the National Health Service (NHS) in England. It is designed to enable patients needing an outpatient appointment to choose which hospital they are referred to by their general practitioner (GP), and to book a convenient date and time for their appointment.

Originally designed simply as an electronic booking system, Choose and Book was developed to enable patient choice. This application has been progressively introduced into the NHS from 2005 onwards.

It was procured as part of the National Programme for IT (NPfIT) in 2003. The contract was awarded to Schlumberger Limited's Sema division just before its acquisition by Atos Origin. The software is based on Cerner Corporation's 'Millennium' e-Booking software.

Surgery where immediate treatment is required is not in the remit of Choose and Book. Such patients' needs bypass any longer-term queuing systems.

Interim Solutions
In its fully functional mode, Choose and Book communicates electronically between 'compliant' GP Clinical Computer systems and Hospital Patient Administration Systems (PAS). For a number of reasons a number of GP and PAS Systems have not been made compliant in time to deliver the Choose and Book targets set by the Department of Health. Interim solutions have been devised to allow patients to benefit from CaB during 2005/6.

Web Based Referral (WBR) allows a GP to access Choose and Book via a standard Web Browser until their Clinical Computing system can be successfully upgraded.

Indirectly Bookable Services (IBS) involves telephone Call Handlers in Hospitals to offer CaB appointments to patients. In a compliant environment, CaB 'harvests' appointment slots from the Hospital PAS. IBS allows a patient to speak to someone who can validate their identity, offer a choice of convenient dates and times from the PAS, then update CaB with details of the chosen appointment.

Progress To Date
The roll-out of CaB in 2005 & 2006 suffered a number of delays; some technical because of its dependency on other NPfIT work streams, partly through functional problems in early releases, and partly through clinicians' concerns about additional workload.

There are conflicting views about its effectiveness, both from a technical viewpoint (it is hard to distinguish between bugs in CaB and the systems with which it interfaces) and a service perspective (some users argue that it undermines existing good practice, while others praise the convenience and reduced delays it offers to patients.)

In order to increase the uptake of Choose & Book by doctors in England, surgeries were offered a financial incentive for the first part of 2006 to 'come on board', but it continues to suffer from adverse publicity in the medical press and resistance from a number of GPs.

Since the application became more stable during 2005 and 2006, volumes have increased, albeit more slowly than planned. At December 2006, over 1,500,000 patients had benefited from CaB. By the end of January 2007, this had risen to almost 2.5M bookings, with daily figures of 15-20,000. All Primary Care Trusts (PCTs) in England are live with Choose and Book (although that may only be one GP within a PCT or practice), while all NHS Acute Trusts are using Choose and Book.) At 28th January, about 90% of practices are actively providing the service, and while some PCTs are only seeing low volumes (20% and less in some cases), many are booking 70 to 80% of patients using Choose and Book.

Extended Choice
In January 2007 the first Independent Sector (or 'Private Sector') Hospitals entered the Choose and Book arena, making their services directly bookable to GPs whose PCT had commissioned their services.

From April 2007, the 'Extended Choice Network' will include all NHS Foundation Trusts and Independent Sector Hospitals who are accredited by the Department of Health as meeting NHS quality and cost criteria. This will mean that a GP can, via CaB, offer their patients the Choice of 4 or more local providers, and the option of any Foundation Trust or accredited Independent Sector Hospital in England.

The Government's intention is that when patients are able to choose between their local NHS Hospital and any accredited Private Hospital in England, standards will rise. (Known as 'contestability').

One criticism of this policy is that patients (and their referring clinicians) will need more access to (and support in using) meaningful information to make a genuinely informed choice.

In March 2007 the first Independent Sector Hospitals became available as Directly Bookable options from within Choose and Book.

Free Choice
In 2007, 'Free Choice' policy will mean that Choose and Book will enable GPs to refer their patients to any accredited provider in England.