An online toolkit is available to back up the ambitions of primary care trusts and hospitals for making choose and book and the 18 weeks promise successful

Primary care trusts have a responsibility to ensure patients receive their elective treatment at the hospital of their choice and within 18 weeks.

Providers need to make all outpatient appointments available on choose and book

Choose and book is an effective tool for this but there are still variations in its use across England. Some providers are also having difficulty managing their outpatient capacity using the system. This can result in patients not being able to exercise their right to free choice, not being able to book their outpatient appointment with certainty and possibly having treatment delayed.

Shortages of appointment slots can occur because a provider cannot meet demand or has reduced its appointment polling range on choose and book (without increasing capacity at the same time); or a combination of the above.

Choose and book medical director Stephen Miller says: “Reducing slot poll lengths without increasing capacity at the same time has only one result - patients are unable to book their appointment directly through choose and book. Instead, they have to go through a process operated by the appointments line, which compounds the issue by creating a backlog of patients needing appointments (whose 18 week referral to treatment time has already started).” 

A central aim of choose and book is to provide patients with greater certainty about their appointment. Lack of available slots undermines this and creates additional work for both hospital and GP practice staff, who then need to manage a confused or frustrated patient and, most importantly, find them an available appointment within 18 weeks.

“nImprovements are needed in the operatioal management of outpatient demand and capacity,” says Dr Miller. “Providers need to make all outpatient appointments available on choose and book and take greater responsibility for actively managing their capacity, so that patient appointments are arranged easily, in the timely manner that was intended”.

Proactive tool

Using the 18 weeks and choose and book toolkit, providers can proactively manage their capacity, increase their use of choose and book and continue to meet the 18 week referral to treatment target.

The toolkit includes: a self-assessment questionnaire, supporting checklist, demand and capacity models and tips and instructions for trusts on managing their capacity.

“Dealing with appointment slot issues is the main implementation priority for the choose and book programme,” says Dr Miller. “There is help available to trusts who want it via their strategic health authority, the national choose and book team and the NHS Interim Management Advisory Services intensive support team, [which] is made up of experienced NHS managers with a sound understanding of operational delivery, who have the specific role of supporting those local health communities who are most challenged in being able to deliver and sustain 18 week patient pathways.”

Case study

Sherwood Forest Hospitals Foundation Trust has consistently been one of the highest users of choose and book across England, with low levels of appointment slot problems. At the end of October 2009, its appointment slot problems occurred in less than 1 per cent of total referrals.

Outpatient and booking manager Linda Pitchford led the work to develop optimum business processes for reviewing choose and book referrals as they came in. They now proactively manage their capacity for first outpatient appointments, by regularly reviewing and adjusting appointment polling ranges, and using real time reporting to understand demand.

Trust chief executive Jeffrey Worrall says: “It’s critical for us as a provider of NHS services to manage our capacity in the most efficient way - to ensure we deliver quality patient care that meets 18 week referral to treatment targets, and use IT to deliver a service that balances operational efficiencies with a quality working environment for our people.

“The use of choose and book by clinicians optimises the referral process and reduces delays, supporting the 18 week referral to treatment pathway. By working with our clinical teams, and taking the time to properly understand the demand for our services in partnership with our primary care trust, we have used choose and book, patient administration system and 18 weeks information to review and change our business processes, streamline outpatient referral pathways, and improve service delivery.”