Choose and Book use by GPs falls

Latest Choose and Book statistics show that use of the system fell after the end of the financial year and numbers are only now beginning to return to levels first achieved in March.

The drop in use of the e-booking system is thought to be partly the result of the Easter break and partly the result of some GP practices stopping use of the system following the end of the national GP incentive payment scheme for Choose and Book. The fall though dispels the impression provided by Connecting for Health of a relentless upward use and adoption curve.

Statistics show that 38% of referrals went through Choose and Book last week, the same percentage achieved four weeks ago. In the intervening four weeks bookings fell from a high of around 85,000 to a low of below 50,000 a week. At the beginning of April Choose and Book medical director Dr Mark Davies made it clear that the intention is still for all primary care trusts to achieve 90% take up of the e-booking system.

Dr Richard Vautrey, a GP in Leeds and one of the negotiators for the British Medical Association’s General Practitioner Committee, said he was not surprised by the fall in usage.

He told EHI Primary Care: “We know that use of Choose and Book has certainly fallen off in the last few weeks. It doesn’t surprise me when the additional workload is burdensome and the benefits are limited.”

At its March meeting the GPC considered recommending a boycott of Choose and Book in protest at GPs’ 0% pay award but decided instead to leave it to individual practices to decide whether to drop the system.

The future of the directed enhanced service (DES) for choice and booking is still unclear although the prospects of the Department of Health introducing a national scheme now look unlikely.

Dr Vautrey said: “The department hasn’t made its intentions known so at the moment there is no funding to support Choose and Book. The longer this goes on the less certain we can be that there will be another DES.”

In the mean time some PCTs are introducing local enhanced service (LES) schemes to encourage GPs to continue to use Choose and Book.

Dr Vautrey welcomed this move which he said could compensate practices for the extra work involved but advised that local medical committees and PCTs should agree a clause that local schemes should no less favourable than any national DES should one be introduced for 2007/8.

In Somerset the LMC has negotiated a LES agreement for Choose and Book. GP practices will be paid 4p per patient for each month that its refers 75% of patients via Choose and Book and an additional 5p per patient if the practice achieves an average of 75% of referrals via Choose and Book for the financial year 2007/8.

Somerset has one of the highest uptakes of Choose and Book in the country and more than half of GP practices achieved the top 90% target for Choose and Book in last year’s DES.

Dr Berge Balian, chair of Somerset LMC, said the scheme had been successful in Somerset because of the “medical secretary method” adopted in the county which enables most of the booking element of Choose and Book to be done outside the consultation.

Dr Balian said all practices already doing Choose and Book, which accounted for the vast majority of practices in Somerset, had indicated that they would continue to do under the new LES agreement. He said the LMC and PCT had set the target at 75% rather than 90% to allow for circumstances where practices where it was inappropriate or not possible to refer through Choose and Book.

He added: “The feedback I have had from practices is that the vast majority will carry on referring people through Choose and Book.”