Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
Editor- Jeremy Wood states that choose and book (CAB) is an
appointment system that has been imposed on us with detrimental effects
(1). The implementation of choose and book was intended to improve
attendance at clinics as the patients had the choice of hospital and the
time and date of appointment.
We have strong evidence that attendance in clinics is worse than the
traditional GP referrals. In a pilot study that we conducted at University
Hospital Lewisham we observed a difference of 18% (CAB) to 12% (GP) with
regards to non-attendance in the clinics. This difference was significant
in a chi-squared test (Chi-squared = 9.6, 1 d.f., p= 0.002). According to
a recent study the majority of patients are not experiencing a significant
choice over appointment time, date or hospital (2).
In our experience it is clear that CAB has failed to achieve its main
goal of improving patient satisfaction and attendance. Moreover it creates
an unnecessary economic burden on the health system and jeopardizes the
prioritization process by removing clinician involvement in
1. Patients get four choices for NHS treatments: Choose and book will hinder development of good outpatient services. Wood J.
BMJ 2006; Jan 21;332(7534):180
2. Does Choose & Book fail to deliver the expected choice of patients? A survey of patients’experience of
outpatient appointment booking. Green J, McDowall Z, Potts WWH. BMC Medical Informatics and decision making 2008; 8:36