Most PCTs to miss 90% Choose and Book target

Only one primary care trust in the country appears to have hit the government’s target for Choose and Book to be used for 90% of referalls by the end of December 2006, a target that his a £100,000 incentive payment tied to it.

Investigations by EHI Primary Care indicate that with the notable exception of Somerset PCT, the other 149 PCTs in England look highly unlikely to have hit the £100,000 capital incentive payment for Choose and Book offered by the Department of Health.

The DH’s three part capital incentive scheme for Choose and Book, launched in 2005, first offered PCTs payments worth £6,000 per practice for registering practices for smartcards and setting up directories of service.

Stage two offered a £100,000 payment for those PCTs referring 50% of patients through the system by December 2005. A final £100,000 payment was offered for referring 90% of patients through the system by December 2006.

While the first incentive payment was earned by many PCTs, only one PCT, Durham Dales, managed to qualify for the second payment.

Somerset PCT believes it may have hit the target, although it is still awaiting confirmation from the DH, but no others are likely to have qualified for the final £100,000 incentive payment.

In the October NHS reorganisation Somerset PCT replaced four previous PCTs which existed in the county so the new merged organisation could therefore qualify for a £400,000 capital payment.

Most other PCTs are a long way behind Somerset. The latest national figures for Choose and Book show 37% of referrals going through the system last week with only two months to go before the end of the financial year. One of the DH’s six key priorities for the NHS in 2006/7 was to have delivered 90% of referrals through Choose and Book by the end of March.

Dr Mark Davies, Connecting for Health’s medical director for Choose and Book, said the DH target of 90% was ambitious.

He told EHI Primary Care: “We always knew it was going to be a difficult thing to do and we know that in March not all areas will have achieved it although some will have done so. The positive thing about an ambitious target is that this has brought it into the minds of chief executives and boards that this is a priority.”

Dr Davies said he believed 90% uptake would be achieved by all PCTs within the next year. He added: “What we are attempting to achieve in Choose and Book is to make it the usual method of referring patients. I talk to lots of people in the NHS about the challenges but I haven’t met anybody who wants to go back to a position where 9.5 million pieces of paper are traveling round the NHS.”

However despite Dr Davies’ optimism there is no doubt there is a long way to go. The highest performing strategic health authority in England, North east SHA, had only referred 39.5% of bookings through Choose and Book in November. Those figures included some relatively high performing PCTs including Sunderland on 49.4%, Middlesborough on 59.2% and County Durham on 46.8%.

In the south west Somerset PCT was already putting 77% of its referrals through Choose and Book in October and the PCT is hopeful it will have reached the 90% target.

Kevin Hudson, programme manager for the Somerset and West Dorset Booking Management Service, said the PCT was waiting for the figures to be confirmed.

He told EHI Primary Care: “We did a concerted amount of engagement with practices near the end of the year and all practices in Somerset tell us they are now doing all referrals through Choose and Book. We certainly feel we are at 90%.”

Hudson said practices used a variety of methods for Choose and Book, including putting bookings through medical secretaries and carrying out bookings in the consultation. He said the BMS was now handling 6000 bookings a month.

He added: “All our trusts are now directly bookable which has made a big difference and we survey 200 patients a month who have used Choose and Book to find out where the issues are and then try and tackle them.”

A series of difficulties have hampered other areas from meeting the 90% target including unavailability of sufficient slots on Choose and Book, technical difficulties, GP engagement and concerns that the system could not be used for named consultant referrals.

However Dr Davies told EHI primary Care that named consultant referrals were possible through Choose and Book and it was not an issue of functionality but a commissioning issue which PCTs and practices needed to take up with hospitals.

Sunderland Teaching PCT was among the top performing trusts towards the end of the year but is still 30% short of the DH target with figures for week ending January 12 showing 60% of referrals being made through Choose and Book.

Stephen Tugwell from Sunderland TPCT told EHI Primary Care: “The system is proving popular with patients and GPs alike, and although we are still working towards the 90 percent target set for March, take-up continues to increase. To date, 51 out of 54 GP surgeries in the PCT area are using Choose and Book, with another two due to be trained by the end of February."

Dr Mike Dixon, chairman of the NHS Alliance and a GP in Cullompton, Devon, said he was not at all surprised that the vast majority of PCTs had missed the DH’s target.

He told EHI primary Care: “I think PCTs are actually doing better than could have been expected given that this system was foisted on the profession without getting their buy-in.”

Dr Dixon predicted that eventually the 90% target would be reached but said much more work needed to be done on the choice aspect of the Choose and Book system with problems such as lack of choice on the system and also the fact that choice was not always appropriate when making a referral.