Abstract :
The implementation of choice for patients over where and when
they are seen by specialists in hospital outpatient clinics has been supported by
electronic referral systems in England and the Netherlands. This paper compares
the implementation of ‘Choose and Book’ in England and ‘ZorgDomein’ in a
region of the Netherlands. For England the analysis draws on national data and
published studies on ‘Choose and Book’, national patient surveys, and qualitative
data based on general practitioner (GP) focus groups. For the Netherlands the
analysis draws on qualitative data collected during observational study as well as
survey data among patients, GPs and medical specialists. We find that despite
significant differences in the genesis and design of the policy, similar challenges
have been faced. The electronic referral systems have forced changes to the
process of care at the interface between primary and secondary care and
standardisation between practices. Although these changes have the potential to
generate improvements and benefits, for example, convenience, certainty and
choice for patients and efficiency gains through for example reduced do not
attend rates, repeat consultations and duplicative diagnostic tests; they have
also generated problems during implementation including GP resistance. Policy
ambitions for patient choice may not be realised if the implementation of the
booking system is not carefully designed and evaluated.
