GPs ‘under no obligation’ to offer choice

GP representatives have told GPs that they are under no obligation to offer a choice of four or five providers from January despite pressure to do so to fulfil the government’s policy on choice at referral.

Delays with the implementation of Choose and Book have led the Department of Health to focus on creating manual solutions for GPs and patients to use including the production of thousands of leaflets and posters.

However the British Medical Association’s General Practitioner Committee this week advised GPs to continue to refer as they have always done, offering choice where local circumstances permit and if it is in the best interests of patients.

Dr Richard Vautrey, a GP in Leeds and one of the GPC negotiators, said some primary care trusts are asking GPs to sign a declaration that they will offer choice through a manual system.

He told EHI Primary Care: “It’s concerning that practices are feeling coerced into doing something which they are not being resourced to support in their practices.”

Dr Vautrey said that while practices were being provided with posters and leaflets there was no recognition of the time involved in discussing four or five choices with patients.

He added: “The vast majority of GPs already offer choice where it is clinically appropriate and in areas such as urban centres. In a rural area it isn’t particularly relevant.”

Last week’s GPC meeting heard from Dr David Wrigley, a GP in Cumbria, that to offer choice to his patients would involve a 200 mile round trip.

The GPC’s advice that GPs should ignore the policy on choice, unless extra resources are provided, is likely to cause difficulties for PCTs charged with delivering the Department of Health’s policy.

Bob Ricketts, head of access development policy and capacity at the DH, last week wrote to PCT chief executives with details of the locally tailored patient leaflets on choice which the department is procuring to support choice at referral.

The DH is paying Dr Foster, a private company which specialisies in compiling health information, to produce the leaflets for every PCT in England. The leaflets are expected explain what ‘choice’ means, suggest some key questions for patients to consider when making their choices and provide basic information on local providers.

Ricketts wrote: “We are only providing details of the choices commissioned for the top 14 specialities. In addition, we have not included pen portraits of the very small community based services, such as GPs with a Special Interest, to help make the leaflet easier to use for patients. However, we will be including a note under the table showing which providers are being offered as choices to indicate that further choices may be available locally which the patient should discuss with their GP.”

In the meantime efforts to increase take up of the electronic Choose and Book system are increasing. Dr Vautrey said his understanding is that 80% of PCTs in England have now placed orders for the fully integrated version of Choose and Book for practices.

Lack of access to integrated systems has been identified as one of several reasons deterring GPs from using Choose and Book as the web based alternative is viewed as being much slower. So far the vast majority of GPs using Choose and Book have had to use the web-based system with 95% of the 20,000 bookings completed made via the web-based solution or by phone.

Dr Vautrey added: “Acquiring the integrated version is a step in the right direction. If the system becomes a useful thing for practices and patients to use efficiently and if there are resources to support it I think practices will start to use it as the year goes on.”