NPfIT Choose and Book fails to give choice to patients?

A study by University College, London, has found that patients are not being offered a choice in appointment times, dates and locations despite the advent of a “Choose and Book” system under the NHS’s National Programme for IT [NPfIT].

Only one patient who took part in the UCL survey was offered a choice of four hospitals, appointment date and time – the minimum promised to patients under the Choose and Book system.

But the study was carried out in 2006 and only a limited number of patients took part – 104. The study is published online in the journal BMC Medical Informatics and Decision Making.

Dr Henry Potts, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), who oversaw the study, said: “It is clear from these results that these patients were not experiencing the degree of choice that Choose and Book was designed to deliver. This may be only one hospital, with results taken in a transitional period, but we believe this could be typical of the national picture.

“Patient choice has been heralded as the driver for transforming the NHS and a means of meeting the expectations of patients. It is cited as the solution to much that is presently wrong with the NHS – from excessive waiting times to even car parking issues.

“It is striking that nobody, up until to this point, has actually asked patients about their experience of the system. These results show the reality of what’s happening on the ground, surely vital when it comes to measuring to what extent this is working or not. This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”


The Choose and Book system was always a good idea, the sort of good idea that comes of sitting in a room with well-meaning colleagues who all agree because nobody around the table wants to be the killjoy who says “but …”.

Choose and Book has turned out well in encouraging some trust boards to think on the possibility of losing patients – and income – to competitors. Poorly performing hospitals could lose patients who invoke their right to choose better hospitals.

For some GPs who can book appointments online quickly the system is liked: it is better than sending out letters to make appointments. But whether Choose and Book will actually make much difference to patients has long been in doubt. Some GPs think it a political gimmick; and they may be right. Tradition dictates that patients will go to the hospital the GP recommends. Besides, a choice of hospitals is relevant only if patients have trustworthy information to judge one hospital against another – and they don’t.


The paper ‘Does Choose & Book fail to deliver the expected choice to patients? is published online in BMC Medical Informatics and Decision Making.

GPs criticise Choose and Book system – Computer Weekly – 2007

Choose and Book, the barrister and the cowpat – 2008

Choose and Book revisited – more disasters – 2008 [NHS blog doctor}

Doctors slam Choose and Book – 2007