How Appointment Slot Issues impact the patient pathway

Patients should be able to book an appointment at their chosen provider using the Choose and Book system, either at their GP practice, by calling The Appointments Line (TAL) or onlnie via the internet. A lack of available appointment slots prevents patients, GPs and TAL from booking appointments using Choose and Book. This creates additional work and inconvenience for providers, practices and patients.

Release 5.0

Since Release 5.0, if a referrer or TAL tries to book an appointment with a specific provider, but no apponitments are available, they are able to use the 'defer to provider' function to inform the relevant provider. The provider then has a responsibility to ensure that the patient is contacted, kept informed and given an appropriate appointment. Patients are also able to forward their details to their chosen provider via the patient web application.

A guidance document Appointment Slot Issues on Choose and Book (PDF 843Kb) explains how the entire process works. It is essential that everyone who uses Choose and Book within your organisation has read the guidance and understands this process.

Simple Measures to Reduce Appointment Slot Issues

There are some simple steps that you can take to improve slot availability within your organisation:

• Do Not reduce slot poll lengths without increasing capacity at the same time: This will only result in patients being unable to book their appointment directly, thereby increasing waiting times.  
• Set specialty specific slot polling ranges: Look at conversion figures for each specialty and set polling ranges accordingly. For instance in Dermatology, many patients receive their first definitive treatment at first outpatient consultation therefore it is appropriate to have a longer slot polling range than, for example General Surgery where patients may be on longer pathways with multiple diagnostics. Therefore a shorter polling range would be more appropriate.
• Allocate all new slots to Choose and Book: If you regularly hold back slots in order to meet your TAL ASI demands, you are effectively compiling tomorrow’s ASI list.
• Minimise carve out. Avoid allocating slots in a general clinic to specific conditions. For example don’t divide an orthopaedic clinic into say 2 hip slots, 2 knee slots, 1 hand and 1 shoulder. Good practice would be to make the clinic generic, thereby allowing equal access to all slots and reducing appointment slot issues.
• Audit appropriateness of referrals and regularly feedback to referrers and consultants: If you regularly receive inappropriate referrals into a service then check the Directory of Services (DOS) or contact referrers to find out why.
• Consider different ways of appointing follow ups: If you work on a specific “New: Follow up” ratio, ie, 30 per cent of slots in a clinic are ring-fenced as follow up slots, consider working differently.  Some organisations, having recognised that follow-up slots have high Did Not Attend (DNA) rates, have moved to “partial booking” for follow ups.  Are all follow ups really necessary?  Could some be discharged back to their GP or seen in a nurse or allied health professional led clinic?
• Consider creating additional capacity by offering non consultant led services
• Understand and manage variation in the system
• Enforce the 6 week clinic cancellation rule: Avoid cancelling clinics at short notice.

Understanding your Capacity and Demand

Choose and Book is an effective tool to support Referral to Treatment waiting time priorities, but some providers continue to experience difficulties in managing their outpatient capacity via the electronic system.  As well as resulting in a poor patient experience and additional administrative work for the provider, this can also result in unnecessary delays to treatment.

Providers should be proactively managing their capacity to ensure that enough slots are always available to allow patients, referrers and TAL to book appointments in Choose and Book.

The Choose and Book National Team are working closely with the Elective Intensive Support Team to help those organisations who are struggling to consistently meet Referral to Treatment targets. If you think your organisation would benefit from some support then please contact your SHA Choose and Book lead who will be able to help you access the support available to you.