Avon unconvinced on Choose and Book

A local medical committee representing GPs with one of the lowest take-up rates for Choose and Book in England says it continues to believe the system is not worth doing, despite a visit from Department of Health officials.

Avon LMC, the second largest unitary LMC in England covering 750 GPs, says usage figures for Choose and Book in most of the primary care trusts it covers is between less than 0.5% and 3%. The low take-up rates prompted a visit from officials last week to discuss what the issues were in the Avon area.

Steve Mercer, chief executive of the LMC, said the meeting had provided an opportunity to exchange views but had not changed the LMC’s advice to GPs.

He told EHI Primary Care: “The LMC’s position is that it is up to individual practices to decide about Choose and Book, taking into account the fact that it’s not in their contract, the workload is unproven and there is no funding outside the directed enhanced service. Practices need to make up their opinion about whether it’s worth doing but in our opinion it’s not.”

Mercer said four of the five PCTs covered by Avon LMC were close to the bottom of the league tables for Choose and Book, which had prompted the visit from DH officials. The fifth PCT in the area, Bath and North East Somerset has a higher take-up rate of 23% because GPs there are running a pilot of the scheme and the PCT was using a referral management centre to handle the bookings. Mercer said Avon favoured setting up a clinical assessment service to run Choose and Book but so far that had not happened.

Mercer added: “What we want is empirical evidence of the workload whereas the team that came down simply said that Choose and Book wasn’t a problem and that they were all doing it easily and we were making a big fuss out of nothing."

Other areas with a low take up of Choose and Book include Sheffield, where the LMC has branded Choose and Book not fit for purpose, and York.

Dr Brain McGregor, chair of the York and Selby sub-committee of North Yorkshire LMC, said the LMC had simply followed the GPC’s advice that GPs should not use Choose and Book unless they believed it fit for purpose and there was appropriate funding.

He said: “There was a strong suggestion that the LMC was blocking practices from going in to Choose and Book but our position has always been to make sure that the system is fit for purpose and right for us and that any costs involved are reimbursed.”

Dr McGregor said most GPs in York had now signed up for the DES and would be prepared to see if they could make it work in their practices. He told EHI Primary Care: “I hope it does work because as GP we want electronic referrals and we believe in choice, but we are still waiting for evidence that it is fit for purpose. In our practice we will do everything we can do to make more than 25% of referrals through the system in June but if we can’t because the system doesn’t work we will give up.”

In Wessex LMC chief executive Dr Nigel Watson said figures for use of Choose and Book were increasing all the time although take up varied across this region.

He said: “In some areas practices are fully engaged with it and doing it and in other areas practices are still waiting for training to get up and running,”

Dr Watson said he used the web-based version of Choose and Book which he found worked well and that those using the integrated system were still facing some problems with requests to verify data and the system crashing.

He added: “I am sure those problems will get sorted out and we’re going in the right direction with that. More importantly though is problems with the way trusts are implementing it which means you cannot choose the local hospital if the wait is longer than 13 weeks and you cannot refer to a named consultant. Those are problems with the way the scheme is administered rather than the software than need to be tackled.”