Authorities flag up problems ahead for C+B plans

Health authorities have until the middle of March to submit plans for meeting the government’s Choose and Book targets but some are already highlighting major threats to the achievement of the milestones.

Surrey and Sussex Strategic Health Authority has put its chances of achieving the Choose and Book targets at ‘red status’ and highlighted the end of implementation funding as a major problem.

Its February board report states that by the end of December the SHA has so far achieved 2% of referrals through Choose and Book compared to 5% nationally, making it 21st out of 28 SHAs in England. To earn the third incentive payment for Choose and Book SHAs must deliver 90% of referrals through the electronic system by the end of December 2006. If that incentive payment is not earned SHAs are still required to deliver 90% uptake by March 2007.

The board report adds: “The key concern is that the added resources funding implementation teams expire this March, while local communities need to move from 2% electronic booking to the December target of 90%. Communities are at various stages of identifying funds to continue implementation, but credible plans for managing the trajectory have not yet been submitted.”

Tad Matus, chief information officer for Surrey and Sussex SHA, said the SHA had given its PCTs until March 9 to come back with plans for how it expected to fund and deliver the Choose and Book targets, ahead of teh March 17 deadline for SHAs to report to the health department.

He told EHI Primary Care: "What the board papers reflect is that national funding for e-booking expires on March 31 because we should have actually have finished doing the work three months ago when it fact we’ve still got 85% of the work to do by December or March next year."

Matus said he thought PCTs in the SHA would be able to meet the targets which he described as "stretching but doable."

He added: "I will feel a lot more comfortable when I see what the PCT’s plans are on March 9."

The health department had provided “additional services resources” (ASR) to PCTs and hospitals trusts to support the technical and training activities for the deployment of Choose and Book since May 2005. Accenture was contracted to deliver the service in the east and northeast clusters and Atos Origin in the other three clusters but that funding has already finished in some areas and will come to an end in the rest by the end of March.

The latest bulletin from the national Choose and Book team highlights the ending of ASR funding and states: “The focus is now on ensuring this investment in the ASR resource is realised by spreading knowledge through to trust and PCT staff.”

However other SHAs report problems with similar slow take-up of Choose and Book. In Greater Manchester use of Choose and Book was only 1.4% in the week ending 8 January.

A report from Mandy Weanes, director of performance and clinical strategy, states: “In view of this poor performance the SHA has escalated its performance management arrangement with weekly reporting of utilisation to PCT CEOs, fortnightly performance management meetings for all PCTs with low utilisation, a programme of one to one visits to PCTs with low utilisation and national escalation of key technical issues.”

A report to the February meeting of Norfolk Suffolk and Cambridgeshire SHA reveals that bookings through Choose and Book range from 22 % in one PCT, Huntingdonshire, to less than 5% in the majority with one PCT, Suffolk West, recording only 0.1% of bookings through the system by 22 January. In his report to the board Steve Clarke, director of performance and finance, said a “series of national technical problems” have had a considerable impact on rolling out Choose and Book in some health communities. His report adds: “The net effect of these problems is that Cambridge University Hospitals is unable to accept any referrals, whilst Suffolk West PCT and East Cambridgeshire and Fenland PCT have formally stated that they will not be rolling out C&B to any more practices until the system is running more effectively. “

Last week Dr David Colin-Thome, national clinical director for primary care, wrote to all GPs to underline the newly-announced directed enhanced services (DES) agreement on choice and booking under the nGMS contract.

He wrote: “The changes to the contract will reward general practice, through a DES, for delivering choice to patients which I appreciate has been an emotive issue with a number of colleagues.”

In his letter Dr Colin-Thome says that many GPs are now able to use the Choose and Book system and that the number of bookings is increasing.

He adds: “Feedback from patients who have used the service has been extremely positive. It also provides a safe and secure means to electronically send the referral to a consultant.”

In a separate letter from the health department SHA chief executives are asked to submit trajectories based on local roll-out plans to deliver at least 90% of GP referrals for first consultant outpatient appointments via Choose and Book by March 2007.

A spokesperson for NHS Connecting for Health confirmed that the  Additional Services Resource will come to an end in its current form at the end of March 2006.

He added: " To date approximately 105,000 PCs have been ‘Choose and Book-enabled’ and 45,000 trainers and users have been trained or attended awareness sessions as a result of the resource made available through 2005/06. The focus is now on ensuring the investment  in the Additional Services Contracts is leveraged.

"Budgets for 2006/07 are being finalised so it would be inappropriate to comment at this time with regards to what level of centrally funded/locally deployed resource will be available to support implementation of Choose and Book in 2006/07."

Links

Letter to GPs on choice and booking

Letter to SHA chief executives