BMA sits on critical Choose and Book survey results

Tags: A BMA Choice Choose and Book Efficiency Engagement GP GPs iS Monitor Patient safety Safety Surgery

12 Mar 2007

The British Medical Association has decided not to publish its own survey of Choose and Book which is highly critical of the e-booking system. A copy of the survey has, however, been obtained by EHI Primary Care.

At the beginning of February BMA chairman Mr James Johnson promised the survey would be published “shortly” but EHI Primary Care has now learnt that the association has changed its mind.

A spokesperson told EHI Primary Care: “We are not publishing the survey as we feel it does not move things on any further. We will, however, continue to monitor how members feel about Choose and Book.”

The existence of the survey was revealed by Mr Johnson six weeks ago at a joint Connecting for Health and BMA conference on IT. He told the conference that the survey, which he promised would be published shortly, showed that Choose and Book was “overwhelmingly unpopular” with GPs and consultants.

The decision not to publish the survey is in contrast to earlier highly public criticism of the e-booking system from within the association. GP representatives at last year’s annual local medical committees conference passed a motion describing Choose and Book as “deeply flawed and not fit for purpose” and a year earlier Mr Johnson himself told the BMA’s annual conference that Choose and Book was a “fiasco”.

The unpublished survey of 279 GPs and 128 consultants carried out between 30 November 2006 and 10 January this year shows that members’ views have changed little since then. Of those who responded to the survey, 78% of GPs and 77% of consultants said they currently used Choose and Book.

A total of 57 % of GPs and 81% of consultants described their experience of Choose and Book over the previous month as negative or very negative and 87% of consultants and 71% of GPs said they would not recommend Choose and Book to a colleague.

Asked about whether patient choice had improved with Choose and Book the majority of GPs (68%) reported that in their view it had not as did 56% of consultants with a further 30% of consultants saying that they did not know.

Consultants appear to be even unhappier with the e-booking system’s impact on patients than GPs with almost 92% of consultants disagreeing or strongly disagreeing with the statement that patient feedback had been generally positive compared to 64% of GPs.

A total of 65% of GPs in the survey did not think the system was user friendly and 69% did not think it was reliable either. On a slightly more positive note 87% of GPs reported that patients generally get the choice they want but 84% disagreed or strongly with the statement that Choose and Book gave them more control over the referral process. Just over 1% of consultants felt that the management of referrals had improved.

When asked to identify the benefits of Choose and Book to patients, 67 % of GPs strongly agreed or agreed with the statement that it allows patient more certainty over when an appointment will be compared with 54 % of consultants. However two thirds of GPs and consultants reported that they strongly disagreed or disagreed with the statement that Choose and Book provides improved patient safety as referrals did not get lost or that Choose and Book provides improved patient safety as they are less likely to not attend.

The survey was commissioned by the BMA’s working party on NHS IT to gather the views of GPs and consultants about the scheme to inform discussion with Connecting for Health and the Department of Health on Choose and Book.

The association posted 1000 questionnaires to consultants and 1000 to GPs and had replies from 128 consultants and 279 GPs.

Only 19% of GPs felt that the Directory of Services (DoS) was accurate with a further 41% reporting they believed the DoS was not very accurate. Just under one in five GPs (19%) said an improved DoS would help the efficiency of Choose and Book.

On the hospital side, engagement with consultants on Choose and Book would still appear to be an issue. The survey found that almost half of consultants (46%) did not know if their department had an entry on the DoS and 28% said referrals via Choose and Book could be made more efficient by a better understanding of the process by all involved.

When asked if there was enough IT support to help them effectively use Choose and Book only 28% of GPs and 7% of consultants agreed that there was. GPs said their main source of advice and support on Choose and Book was their colleagues whereas consultants’ main source of support was their trust. The two areas which GPs believed had caused them the most problems with the Choose and Book system in the last month were the speed of the online system and availability of services to refer to, both of which were highlighted by 18% of GPs.

GPs and consultants were asked to identify reasons behind the need to rebook appointments - 38% of GPs felt that the number of referrals sent back had increased under Choose and Book.

A total of 26% of GPs said rebooking was necessary because of hospital rescheduling of appointments and 24% said rebooking was necessary because of an inability to refer to a named consultant. More than a quarter (28%) of consultants said the most likely reasons for rebooking an appointment were that the referral was incorrect, with 20% saying rebooking happened when the priority of the referral was incorrect.

A majority of GPs (51%) reported that consultation length had significantly increased as a result of using Choose and Book. and consultants who were not using Choose and Book were able to add their own comments about why not.

One GP commented: “We have just decided to stop, having been in the top 100 practices for usage, as the local hospital has started to tell patients that there are no appointments available, when the patient rings to book, and asking the patient to contact our practice! - what are we supposed to do?’ Another said: “Complaints from patients over difficulties in getting through . . . all of this fed back to me in wasted surgery time.”

Readers Comments

shambles

12 Mar 07 11:42

"The association posted 1000 questionnaires to consultants and 1000 to GPs and had replies from 128 consultants and 279 GPs" - this is far too small a response to be held a indicative of GP/consultant opinion; one would expect a skewed response as those with a positive experience/opinion are less likely to respond.

However it doesn't hide the fact that there are huge problems with C&B as a whole but it does not prove it either. Until the effective gagging order on those involved in C&B and other NPfIT services is lifted will any real light be cast on problems and solutions found?

Of course BMA should publish

12 Mar 07 11:50

This provides important evidence concerning a significant government "initiative."

It seems that to publish is in BMA members' interests. Not to publish is in the government's interests.

Interests

12 Mar 07 12:17

Not publishing it is also in the interests of some of those on the BMA's Working Party on NHS IT....

BUT.....

12 Mar 07 13:47

BUT (and this is a big but), this is a selective response and a small response from a smal sample and therefore statistically insignificant

It cannot be said that a majority believed anything when it is actually the majority of the minority (if you get my drift) responding to the original survey; itself a small sample of all GPs and consultants.

I'm not saying that all GPs wouldn't agree with the results put forward but the fact is that they didn't respond in that manner.

I am not pro-C&B in any way apart from the concept; I believe that proper testing and engagement should have been undertaken prior to a live rollout but this report is not helpful at present.

Statistical significance

13 Mar 07 15:25

I think the BMA should publish. I never got too far into the damn lies that statistics can be, but I believe that a 30% response rate to a survey is normal (GPs 28%), and that 100+ can be taken as a statistically significant indicator. Many medical advances rely on nuances of chi-tests etc on smaller sample sizes than this.

The majority of people do not vote, but we don't take that as an imperative to have no government, if there were an equal number of enthusiastic GPs, where are they, cos I can't find any. Even the most engaged moan about the poor software and performance.

It does not suprise me at all that the consultant response is lower and more oblivious. In absence of the Care Record, many will still be dealing with paper records, and hospitals have shielded them from the horrors by using admin staff to handle C&B and conventional referrals.

So is the BMA interest in the incentive payments ?

gamesmanship

mark.spencer@gp-e85028.nhs.uk

13 Mar 07 19:22

I used to be GP IT lead in the PCT, but when that meant having to support a slow, poorly implemented system I had to stop.

C&B is slowly getting better - but very slowly. I am meant to be a clinician not a booking clerk.

On the otherhand my PBC group now has one of the highest uses of C&B in London - because all of the referrals go through a Clinical Assessment Service (CAS) - and they phone the patient and do the C&B bit. Reluctant GPs happily signed up to CAS so they could avoid C&B (and as their referrals go through C&B they get the incentive payment. So avoiding C&B is a great carrot!

Choose and Book DOES work AND works well almost all the time

amir.hannan@nhs.net

13 Mar 07 19:54

As a GP in a very busy practice with a significant Bangladeshi population that does not speak English, I have been extremely impressed with Choose and Book as have my patients. Whilst I am going through the Choice menu and offering my patients an appointment at their convenience, they often ask whether they will need to wait for a letter in the post to confirm their booking. As they end their question, my printer is printing off the confirmation slip with a date and time for their appointment. If a hospital cannot offer an appointment within 13 weeks then that is a challenge for the local health community (PCT and Acute Trust) to look at ways of enabling the hospital to provide the slots - it is not the fault of Choose and Book. I challenge anybody out there to come and see me in action whilst I am doing a referral to see how I do it. Thankfully I am not an isolated clinician as many colleagues and those from other professions are using this and using it well.

I agree that there are times when it does not work but that's a rare occurrence. I have been using Choose and Book since it was launched and have probably had to delay the referral on only about 5 times (out of the hundreds and hundreds of referrals I have had to do).

I cannot argue with different people's experience - this cannot be changed. But the idea that we can, or even should, stop using Choose and Book and go back to the old ways of working where patients have no idea when their referral will be and they can only go to the place where I decide for them as a GP would be a disservice to the public, our patients and our profession.

This is a time for us to build on what IS good (which is the majority), consider those aspects that are not so good (which often reflects deeper problems within the NHS), work with fellow clinicians (GPs, consultants, nurses and allied health professionals) and make IT happen for us and our patients. (Member of the Clinical Leaders Network)

Re:Choose and Book DOES work AND works well almost all the time

mary.hawking@nhs.net

17 Mar 07 20:16

C&B is a two way process - and I am a pragmatic GP. In my area, direct booking is not supported: clinics are closed because of the imminent arrival of the 18 week wait target - great for hospitals: just close for referrals until the waiting lists reach the desired levels - after all, patients will have to "choose" to be refered elsewhere! It *could* be a benefificial system *if* and only if the problems were sorted. 1. clunky and slow software 2. availability of slots and availability of transport for the marginally needy - those who do not qualify under normal rules - but cannot manage multiple changes on unreliable public transport. 3. adequate information on the services on offer - and the quality of these services 4 a solution for patients who feel they have a need to conceal their address and home phone - e.g. anyone who might be targeted by the animal liberation front terrorists - and are therefore unable to make appointments under C&B. This *is* a problem when Trusts will *only* accept referrals if they are made through C&B. Your demographics or (potentially* your life - and treatment - vis a vis the NHS?