GPC says key questions unresolved on Choose and Book

In a cautionary guidance note issued this week the GPC advises practices that key aspects of how Choose and Book will work remain unclear and advises them to “carefully consider the implications of being involved in Choose and Book.” It adds: “Choose and Book is not part of a GP’s contractual obligations and therefore practices can decline to be involved."

Though it stops short of advising practices to boycott the system, the guidance note is extremely cautionary in tone and implies that practices should very carefully consider whether they should use the Choose and Book system until the outstanding concerns have been resolved with the Department of Health. 

The GPC’s advice, if heeded by practices, could potentially derail the roll-out programme for Choose and Book, which is an essential part of the Government’s commitment to have a fully booked NHS initially for first outpatient appointments by the end of 2005. 

While welcoming developments that provide an opportunity for patients to become more involved in when and where they are treated, the guidance note stresses that key details remain unresolved. These include how the Choose and Book system will operate, together with the mechanisms it will use for ensuring confidentiality and security of patient information. The impact of Choose and Book on practice workload also remains unclear or unresolved.

The most serious of the GPC’s concerns is the confidentiality and security of patient information. It notes that at part of the electronic referral process needed to complete a booking request, the Choose and Book system is intended to automatically extract data from the patient’s GP computer record, and possibly pass some of this confidential data onto the NHS Data Spine. 

“The GPC has not yet been shown how this will work,” reads the guidance notice. “We understand that the system is supposed to automatically extract data from the patient’s GP computer record. This is an area of enormous complexity and will require close examination. The automatic extraction of data from GP records is fraught with all sorts of difficulties."

Dr Paul Cundy, chairman of the joint Royal College of General Practitioners and GPC IT committee and author of the GPC guidance told E-Health Insider: “The e-referral module of Choose and Book crept in out of nowhere… I had no idea Choose and Book was an e-referral system as well."

Turning to the issue of patient data being passed to the spine during an e-referral, the guidance advises that this is contrary to motions passed by the BMA’s Local Medical Committee (LMC) conference in the summer. These motions stated that until guarantees had been provided on how the confidentiality of patient information would be preserved, GPs should not allow patient identifiable data to be sent to the spine.

“The GPC has not seen the technical specifications for Choose and Book and cannot vouch for its security. We are unaware of any technological provisions to protect privacy and confidentiality," says the GPC guidance.  

Dr Cundy added that the Choose and Book system he’d had demonstrated to him contains no indication of how security is handled and that all the website for the project says about e-referral “is that ‘everyone in the NHS is bound by confidentiality’, which is about as useful as a poke in the eye with a hot stick."

Dr Cundy said that it was a shame that, unlike the highly successful QMAS project, the GPC had not been involved at all in Choose and Book: “[This] appears to run roughshod over doctor’s concerns about the confidentiality and security of patient data."

Other areas of concern highlighted in the guidance include the impact on practice workload, the impact on GP-patient consultations, and the lack of any additional resources for practices to take on managing bookings and referrals.

“The GPC are very concerned about the workload implications of Choose and Book," states the guidance, warning that there is a danger it will place an additional unfunded workload on practices.

It adds: "It will be difficult for GPs to complete a Choose and Book appointment within the confines of a ten minute consultation, and we are concerned about the consequent effect on the quality of those and subsequent consultations.

Finally, the guidance stresses that Choose and Book “is not a requirement of the new General Medical Services contract”, and that resources to take on the additional work entailed “are unlikely to be made available" to practices.

A spokesperson for the National Programme for IT, responding to concerns from the GPC, said that Choose and Book would be a “bonus not a burden”, and that "extensive consultation has taken place with front-line clinicians to ensure that Choose and Book supports current working patterns and practices among doctors. The National Programme has been working with a number of early adopter sites to learn lessons, and refine the approach wherenecessary, before the project is rolled out more widely.

“Those GPs involved so far are positive about the benefits for patients, and satisfied with the measures put in place to ensure confidentiality and security."

GPC Guidance Document