Choose and book: not a patient-centred service?

Introduction: As part of another study we monitored Choose and Book (C&B) referrals attending our respiratory clinic and asked their views on their referral process. High non-attendance and limited patient choice with the C&B system has previously been observed elsewhere, despite it being intended as a patient-centred service enhancement. We sought to gain insight into non-attendance of C&B referrals at our clinic by analysing the levels of satisfaction with the referral process expressed by those who attended. Method: C&B non-attendance/cancellation rates were calculated for the initial study recruitment period. Patients attending clinic were asked to confirm their referral route and their satisfaction with the referral system via a nurse-administered questionnaire. Results: 47/57 (82.5%) C&B patients attended clinic during the study recruitment period. 2/57 (3.5%) rearranged to a different clinic. 8/57 (14%) failed to attend or cancelled. 44/47 (93.6%) patients who attended clinic responded to the questionnaire. 18/44 (40.9%) patients reported limited or no choice regarding time/date or hospital location of the appointment. 4/18 (22.2%) said the appointment was arranged by their GP. A further 7/18 (38.9%) seemed unaware of the C&B system or that they had a choice. 5/18 (27.8%) would have chosen a different hospital and 3/18 (16.7%) would have chosen a different date/time. 3/18 (16.7%) failed to get their preference using the online/telephone booking systems. In 12/44 (27.3%) cases the GP either made or assisted with the booking: 4/12 (33.3%) patients were happy for the GP to choose, 4/12 (33.3%) described a consultative process, 2/12 (16.7%) felt choice was limited and 2/12 (16.7%) made no additional comment. Only 16/44 (36.4%) mentioned using the telephone/online booking systems. 5/16 (31.3%) commented that the choice of dates or location that this provided was important to them. Patient reported problems with the systems included limited options and inflexibility when booking or rearranging appointments and a lack of information. 12/44 (27.3%) specifically mentioned that they liked the choice and convenience the system offered. Conclusion: Our findings suggest that a high proportion of respiratory patients do not exercise true choice with Choose and Book. This supports observations in other patient groups. System and process obstacles seem to be exacerbated by lack of patient awareness and may be contributing to high non-attendance rates.