A hospital referral from a GP is usually followed by a long wait, but under new government regulations this could become a thing of the past. As part of the NHS Plan, all NHS trusts must have an online booking system in place by 2005.
An early frontrunner in this area is the City Hospital NHS Trust in Birmingham, which has created an online appointment booking system called Rapport in association with local GP Karl Olonzo and software provider Isis Technology. This system enables GPs to book patient appointments instantaneously and make referrals to consultancy clinics direct from their practice.
The project received a boost when it attracted funding from the Government's National Booked Admissions Scheme, which helped pay for the 18-month pilot that ended in April 2000. But testing the system was not the major issue. The hospital's patient process director Millar Bownass explains, "The computer systems worked. It was getting the GPs to use it that was the difficult bit."
The hospital realised early on in the trial that a lot of the GPs weren't using the system. The problem was that the GPs had to revert to the old system to refer patients to consultancy clinics at the hospital that were not included in the trial. Rather than flit between the two, a lot of GPs were simply sticking to the old paper-based system.
The hospital realised that to encourage use it would have to add more functionality and make the system universal. The resultant changes allowed GPs to send all referrals to the hospital via e-mail.
Bownass explains that the idea was to make booking an appointment electronically second nature to GPs. A Web site was developed to allow them to view hospital records, beginning the idea of sharing patient records between local surgeries and the hospital.
The improved version of Rapport was then promoted among local GPs, with Bownass and his assistant making a number of visits to local practices. "That is been the key to success without a shadow of a doubt," says Bownass. "You need personal contact."
The second wave of the project ran from April 2000 to April 2001 and involved the roll-out of the scheme to more local GPs. The hospital received further funding for this phase but the current third phase has been funded internally by the hospital.
The scheme has two key benefits for patients. In the past, it could take about two weeks to book an appointment to see a consultant, whereas now an appointment can be arranged instantaneously. In addition, as patients are given a choice of appointment slots, they are more likely to be offered one that suits them, cutting the chance of patients cancelling appointments or not turning up.
The system also offer benefits for GPs and consultants. When the GP sends the referral to the clinic they are provided with clinical information and advised on how to prepare the patient for the appointment. Because GPs have to negotiate a referral protocol, typically involving about six or seven questions relating to the patients' symptoms and condition, the consultant is able to prioritise more serious cases.
However, it has not all been plain sailing. There were some major technical problems that needed to be ironed out. For example, the general practices covered in the scheme were running different IT systems of varying ages and performance capability.
As GPs were using a mix of different software, it was necessary to create a system that would allow documents to be transferred from application to another. Rapport also had to be able to communicate with the hospital's patient information system. This is where the software created by Olonzo and Isis Technology came in.
At present, the hospital is receiving about 30 direct bookings per month, compared to three a month nine months ago. These referrals cover a range of clinics including early arthritis, rapid access chest pain and all of the hospital's cancer clinics - in line with the NHS' "two week wait" initiative.
According to Bownass, one of the reasons why the number of referrals is still relatively low is that the hospital has listed the most serious conditions first - conditions for which GPs would very rarely see more than one or two cases a year. However, this should change as the hospital adds more common conditions to the system, such as urology and dermatology, which are high volume areas for outpatient departments.
Urology and dermatology also involve a more complex referral procedure. For example, the dermatology clinic at the hospital contains a number of sub-clinics such as eczema and psoriasis.
"That was one of the reasons we waited on these areas," says Bownass. "We are not into big bang - we do bite-size chunks you can actually achieve."