GPs urge rethink on Choose and Book

Primary care trusts (PCTs) will fail to persuade GPs to use Choose and Book unless the system is overhauled, according to GP representatives.

In the meantime, PCTs look likely to direct most of the work via Booking Management Services (BMS) with only GP enthusiasts booking appointments themselves.

Dr Paul Cundy, chair of the BMA’s General Practitioner Committee’s IT sub-committee, told EHI Primary Care that the £95m extra funding announced by the government two weeks ago will have little impact.

“It’s a cynical attempt to throw money at the problem and it will make no difference whatsoever. The government is not listening to what we’re saying which is that they need to change the system."

Cundy has devised a ten-point salvage plan for Choose and Book and says the booking system needs to be cut down from about 20 steps to just three.

He added: “As it is at the moment no GP is going to go anywhere near it. It’s going to take the average GP seven to ten minutes to do it and that’s just not possible in a fully booked surgery because its unpredictable and you don’t know when you will have to refer someone."

Preston PCT is an early adopter for Choose and Book and is planning to use a BMS for all bookings when the system goes live in the next few days.

Dr Dinesh Patel, a GP in Preston and member of the PCT’s professional executive committee, said the PCT had a good relationship with GPs and tried to develop a pragmatic approach to government policies.

He said: “There would have been mass resistance to the idea that GP do the bookings and the PCT quickly realised that."

Instead GPs will refer patients as usual, practice staff will complete a web-based template and the BMS will contact patients to make the booking. Ultimately it will be the responsibility of the patient to contact the BMS.

Dr Patel said the only requirement on GPs was that all referral letters must be sent within five days. Three-quarters of practices in Preston have signed up for the scheme. By the summer GPs that want to do bookings from the consulting room will be able to but there will be no pressure to do so.

Dr Mike Dixon, chairman of the NHS Alliance and a GP in mid-Devon, said Choose and Book had been a communications disaster. He added: “Most GPs don’t really understand what Choose and Book is and how it’s going to work. GPs don’t feel any ownership and don’t want to be involved."

He said the 60 GPs in mid-Devon were not keen to get involved and he had received similar feedback from other PCTs. Dr Dixon said the £95m could be used to pay practice staff to do the work.

He added: “General practice has a history to getting the job done if it’s paid to do it. If GPs feel able and willing that’s great. But PCTs will face a struggle to get GPs to do it in the surgery. The Alliance’s view is that it could be done by PCTs."

Dr Mayur Lakhani, chairman of the Royal College of General Practitioners, said the £95m funding might not have the desired effect. He added: “The problem is the scheme hasn’t won the hearts and minds of GPs."

However he said the college would work with NPfIT at a policy level to ensure GPs received the support they needed.

Dr Nigel Watson, a GP in Southampton and chief executive of Wessex Local Medical Committees, said most GPs in his area were not prepared to use the system as it stands. He said: “I haven’t met a GP yet who thinks this is a good way of doing it."

Dr Watson said Choose and Book was installed in his own practice. He added: “I have used it for a simple referral and it took a couple of minutes but for the majority of referrals it would take far too long."

He predicted that PCTs in his area would use referral management centres to manage bookings for the majority of patients.

Some PCTs are reporting more success. Terri Holcroft, Choose and Book project manager for North Mersey Health Informatics Service, said most GPs and consultants in North Mersey were keen to get involved. Holcroft added: “We have quite a few practices who want to go first and others who want to do it but prefer to wait until it has settled down."

She said many practices in North Mersey were already doing electronic referrals and saw Choose and Book as an extension of that work. The Health Informatics Service has a group of GPs and consultants who worked on the e-referral project and are now drawing up guidance for Choose and Book.