High trust Choose and Book deal to boost uptake

A primary care trust is introducing a high trust incentive scheme for Choose and Book, which it believes could be the model for PCTs nationwide.

Bedfordshire PCT is to pay GPs 48p per patient to take part in its new Choose and Book local enhanced service (LES). There will also be additional payments of up to a total of 80p per patient for those practices using Choose and Book for 85% of referrals "that were available for electronic booking".

Practices will not have to make monthly or yearly returns of their Choose and Book referral activity, and will not be required to enter extra notes on the patient record about the method of booking used on each occasion.

GP practices signing up for LES must only provide assurances that they will try to use electronic booking as much as possible, where it is available. At the end of the financial year they are then required to formally state that they have completed the process.

Just days after its launch, a total of 71% of practices have signed up to the scheme and the PCT believes more practices will join in the coming weeks.

Mark Peedle, head of primary care IT for NHS Bedfordshire, said the 48p upfront payment would encourage practices to use the e-booking system. “I trust them to use the system,” he told EHI Primary Care.

Peedle said usage of Choose and Book in Bedfordshire was currently about 40%, more than 10% lower than the national average and placing the PCT 123rd out of 152 trusts, but he expects that to rise substantially higher with the advent of the LES.

He added: “There are so many interdependencies but we are working to iron those out. In an ideal world, I would expect to see uptake increase to 90 or 100% but definitely much higher than it is now.”

Dr John Lockley, a GP in Bedfordshire and a member of the National Clinical Reference Panel for Choose and Book, said that NHS Bedfordshire had recognised that it was unreasonable to measure practices’ compliance as a percentage of total referrals, when many referrals still have to be made in paper form or when the Choose and Book website is down.

He added: “What I like most about this is its high trust nature. It treats us as honourable professionals and in turn we treat them as honourable managers.”

The PCT is also to launch its own website that will list all outpatient clinics and secondary providers and whether they are electronically bookable or not.

Dr Lockley said: “The trouble with the national Choose and Book website is that you look for something and, if it involves a paper referral, it is not there or you just can’t find it.

“I would hope this website and the rest of the LES could be a model of good practice that could be emulated up and down the country.”

Dr Bruce Ella, co-chair of NHS Bedfordshire’s Choose and Book subcommittee, said the PCT had taken the sensible step of trusting GPs’ integrity rather than generating paper mountains to micro-manage them.

Dr Lockley added: “Practices will be paid for the actual effort they put in, rather than having to spend extra time administering the LES.”

Peedle added: “It builds upon the collaborative approach I take with all information systems in use in general practice.

"In addition to the trust I have in practices to do the best they can to use the system, I also recognise that the introduction of a new system into any environment will result in changing established ways of working. Rather than being a ‘reward’ for practices that use the system, it is a recognition that change has a cost.”