Will new patient booking system be a cure for previous NHS tech failure?
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Version 0 of 1. Is Jeremy Hunt’s agenda for a paperless NHS about to take a dramatic leap forward? On 15 June, the long-awaited NHS e-referral service will go live. According to NHS England, its new service will build upon its predecessor, Choose and Book, acknowledging its failures and lessons learned. An NHS England spokesperson said: “We are committed to achieving our vision of all referrals across care settings being completed electronically by 2018, ensuring that appointments are managed in a modern and effective way. We have built a new system which is easier to use and are working hard to support doctors and nurses to move away from paper.” Choose and Book, the electronic booking system for outpatient appointments, was introduced by the Labour government to enable patients to select, with their GP, a hospital appointment at a convenient date and time. The decision to replace the system, which has cost £356m since 2004, with the NHS e-referral service, came following a drop in its use by doctors and patients. Although it was intended to speed up the appointment process and reduce paperwork, many found it difficult to use and time-consuming. Not all outpatient appointment slots were available on it, limiting its usefulness. Unlike Choose and Book, which was outsourced to Atos as part of the NHS national programme for IT, responsibility for developing the new service has been taken in-house under the control of the Health and Social Care Information Centre (HSCIC). Although it has been delayed – e-referral was due to launch last November and then spring 2015- this was due to extended testing. Stephen Miller, a GP and medical director for the NHS e-referral service, says users will not initially see any big changes from the current bookings system. ”We’re conscious that to some people that may be a disappointment,” he says. “But if we had gone and introduced a brand new system with lots and lots of changes from day one, we suspect that we would probably have got more criticism.” The NHS has a poor record on implementing large-scale IT projects. Choose and Book, intended to replace traditional paper referrals with an integrated electronic system, was no exception. It has cost more than £350m since 2004 and the public accounts committee estimates that it failed to achieve potential savings of up to £51m annually. Related: Digital revolution brings data challenges for NHS “Choose and Book was a disaster,” says Dr Neil Bacon, founder of online patient forum iWantGreatCare. “There was no real choice because of a lack of information. Typically there was just a list of hospitals, you can’t choose a consultant and there was no information about the service.” Dr Chaand Nagpaul, chair of the British Medical Association’s (BMA) GPs committee, thinks new technology will not suddenly deliver improvements where there are other limiting factors. For example GPs can only make referrals to named consultants on paper and a large number of services were not available on Choose and Book appointment slots. “In many parts of the country there are whole specialties that have not made their appointments available for electronic referral. Just changing the technology is not going to solve that problem,” he says. Outcomes data could to be added to the e-referral service – the problem is they are not comprehensively collected. Nagpaul thinks NHS England is right to focus its new service on the potential benefits to the user, rather than choice and a plurality of providers, but adds: “Ultimately the proof of the pudding will be in the eating because we have yet to go live and we need to see if the technology is actually more efficient and simpler and faster to use. Another criticism with Choose and Book is that it was slow. And we need to see if there is adequate training and support for practitioners to take this up.” Choose and Book was woefully underused and NHS England faces a challenge to gain acceptance for its replacement. The organisation has held discussions with more than 2,500 “key stakeholders”, including clinical commissioning groups and patients, in an effort to get it right this time. Nagpaul thinks the new system has to sell itself: “We know that GPs do use technology when it’s working well, when it’s effective, when it has benefits. You look at GP-to-GP record transfer – that’s been well used by GPs because it works and it’s good for patients and good for clinicians.” Natalie Bateman, head of health at IT industry body techUK, would like to see the e-referral used beyond outpatients across health and social care. “We will still have a mixed economy of paper and digital in the sense that e-referral does not cover the whole system,” she says. While she welcomes NHS England’s intention to deliver e-referral on mobile devices, she regrets that the system will not work in real-time so that appointment changes or cancellations are immediately available to other patients. Related: NHS staff should play a bigger role in health service changes Unlike its predecessor, e-referral uses open IT architecture and infrastructure and Bateman sees this as a positive step because it allows for innovation from third parties and for the evolution of the service. HSCIC’s intention is to introduce smaller software changes every two to three weeks and bigger changes every couple of months in response to users’ needs. The launch of the e-referral service will mark a start, not of a finished product, but of an iterative process. It will need to evolve alongside changes in health services and technology. Nagpaul says: “There is real potential here if it works effectively, but the onus is on NHS England to get it right.” |