New C+B incentives from April announced

Practices will be able to earn approximately £2000 per partner if they can meet government targets on choice and booking by March 2007, the detailed guidance on the new payment scheme reveals.

Guidance from the BMA’s GP committee and NHS Employers on changes to the nGMS contract from April spells out how the one year agreement for a direct enhanced service (DES) for choice and booking will work.

It makes it clear that GPs must use the electronic Choose and Book scheme rather than meeting the targets manually, contrary to the scheme described by the BMA when the outline of the DES was announced in December.

The DES, worth a total of £50m, offers an overall payment of 48p per patient for offering choice and 48p per patient for booking patients through Choose and Book. The two payments, both in two parts, are separate and not dependent on each other.

Practices will be paid 24p per patient, based on the practice’s list size on 1 April 2006, if they can provide their primary care trust with a written statement that clinicians will offer “clinically appropriate choice” to patients.

The DES makes no mention of the requirement to offer four choices, a key part of the government’s choice policy. The remainder of the choice payment will be paid if at least 60% of patients who respond to a new national patient experience survey recall a conversation about choice with their GP. The second part of the payment will be passed on the practice’s list size on 1 January 2007.

Practices can earn the first part of the Choose and Book payment, an aspiration payment worth 24p per registered patient on 1 April 2006, by providing their PCT with a written statement that demonstrates a commitment to using the Choose and Book system.

However, this payment will be reclaimed if the number of Unique Booking Reference Number referrals converted into bookings does not reach or exceed 25% of all referrals in June 2006. UBRNs are the numbers generated by the Choose and Book system which allow patients to book their appointments through Choose and Book, either in the practice or later via a call centre or on the internet.

The Choose and Book element also requires practices to generate and attach a referral letter to an appointment request or auto-generate a referral letter via a GP integrated system, within agreed time limits.

For cancer referrals or other urgent referrals, this must be within one working day and for routine referrals normally three working days unless there are exceptional circumstances such as delays for inclusion of any results, or when information cannot be forwarded subsequently.

The rest of the Choose and Book payment, a total of 24p per registered patient at 1 January 2007, will be triggered on a sliding scale passed on the percentage of outpatient referrals made using Choose and Book by the practice, assessed by the number of converted UBRNs, between 1 September 2006 and 28 February 2007.

The minimum threshold is 50% which is worth 60% of the payment, 70% referrals is worth 80% of the payment with the full 24p per patient only paid if the practice achieves 90% or more referrals through Choose and Book. The data will be generated by Connecting for Health reports throughout the year.

If practices fail to implement and use the booking systems “due to circumstances beyond their control” such as national and regional difficulties the guidance says the commitment to award payment to practices will still apply and the practice should receive a pro-rata payment for the work that they have completed. This payment is to be decided by the PCT.

However those who fail to achieve the targets without such difficulties will have to repay the initial aspiration payments.

Directed enhanced services schemes are a mandatory part of the new contract which PCTs are obliged to commission from practices in the first instance.

The government’s latest target on the troubled Choose and Book scheme is to deliver 90% of referrals through the system by March 2007.