Choose and Book progresses amid target row

More than 20% of referrals are now being made using Choose and Book, according to latest figures from NHS Connecting for Health, but the scrapping of usage targets has upset several practices.

Over the last two months the number of referrals going through the e-booking system has increased from an average of 6,000 a day at the beginning of May to a peak of 10,638 on 10 July.

The increase in use of the system is thought to have been largely prompted by practices working to meet the choice and booking directed enhanced service (DES).

However a decision to scrap the first target for the DES which required 25% of referrals to be made through the system in June has infuriated some practices who managed to achieve the total.

They claim the original DES wording meant the achievement of the June target would have allowed GP practices to retain their aspiration payment for Choose and Book, worth £1,320 to the average practice with 5,500 patients, and instead they now need to reach at least an average of 50% of referrals between September and the end of February to keep the payment.

This is disputed by the British Medical Association’s General Practitioner Committee (GPC) and the Department of Health (DH) who claim the scrapping of the June target makes no difference to the incentive payment arrangements which were always reliant on meeting the 50% target for September to February.

Dr Neil Bhatia, a GP in Yateley, Hampshire, claims the rules are ambiguous at the very least and says his PCT, Blackwater Valley and Hart, is about to write to practices who have achieved the target to reassure them the aspiration payment will not be clawed back, even if they fail to meet the 50% target.

Dr Bhatia told EHI Primary Care: “The majority of practices who have taken this on believed that you had to do 25% to keep your aspiration payment and that there was no link to the target for 50% or more referrals because many practices decided to go for the first target although they weren’t sure if they would get to the 50% target.”

A letter sent by the DH to PCTs on 1 June about data collection for Choose and Book appears to back up Dr Bhatia’s stance.

It states: “Aspiration payments have been made based on a commitment to use Choose and Book, and may be retained providing practices make 25% of their referrals through Choose and Book in June 2006.”

Dr Bhatia sits on the Choose and Book board for his PCT and said about a quarter of practices have achieved the 25% target.

He added: “My PCT is to honour the agreement but it’s unfair and unacceptable for practices in other PCTs to change what all of us believed we had signed up to.”

Dr Richard Vautrey, deputy chairman of the GPC and its lead on IT issues, insisted that practices would have been unable to retain their aspiration payments under the old arrangements even if they had met the June target.

He told EHI Primary Care: “It’s always been the end of the year target that has counted. The 25% target was an encouragement to practices to start on the road to using Choose and Book.”

A practice manager in Cambridgeshire said the removal of the June target was in some ways good news for her practice which had achieved just under 25% of referrals through the system last month. However she said it would be “exceptionally difficult” to meet the 50% target, particularly since some specialisms were still unavailable via Choose and Book.

According to CfH 100% of acute trusts are now live with Choose and Book and 70% of practices have used the system.

Professor Michael Thick, Choose and Book medical director and senior adviser to CfH, said the achievement of 20% of referrals through the system was testament to the hard work that the NHS has undertaken.

He added: “As a programme we still have some challenges ahead; for example supporting trusts to publish more slots, developing processes for two week wait referrals and rolling out compliant PAS across the country. But we’re making good progress on these and the increase in bookings demonstrates that the core service works and is fit for purpose.”

Related stories

June C+B target for practices scrapped