Choose and Book use on downward slope

Usage of Choose and Book has fallen from a high of 57% to 50%, with some areas almost halving their use of the Department of Health’s e-booking system.

Figures for NHS Hertfordshire show use of Choose and Book has dropped from a high of 60% of referrals to 35%.

In Bedfordshire, usage has fallen from 53% to 27%, and in Eastern and Coastal Kent it has fallen from 58% to 32% in January this year.

Some areas have maintained or increased usage. In Bournemouth and Poole, Choose and Book is used for 100% of referrals. However, the overall national trend is downwards.

The DH told EHI Primary Care that it could confirm the utilisation for January 2012 was 50%. February figures will not available until the end of this month.

When Choose and Book was launched in 2005, the then-Labour government set a target for it to be used for 90% of first outpatient appointments by 2007.

However, the largest percentage of referrals sent through the system has been 57% in January and February 2010.

A DH spokesperson said: “We are actively liaising with strategic health authorities, primary care trusts and those clinical commissioning groups that are formed in order to analyse the causes.”

She added: “We remain committed to working with the NHS (including GPs) to embed Choose and Book into daily clinical practice, so patients can reap the rewards of greater choice and more efficient healthcare.”

The fall in use of Choose and Book in areas like Hertfordshire has been linked to the end of GP funding for use of the system.

This was first provided through a national directed enhanced service and then followed up with local incentive schemes in many PCTs.

Dr Peter Graves, chief executive of Bedfordshire and Hertfordshire Local Medical Committees, told EHI PC that “historically, there were a host of difficulties with the system both nationally and locally.”

“[There were issues] such as difficulties in sending patients to the right consultant, clinics disappearing in front of GPs’ eyes, and patients turning up at the wrong hospital because it was unclear where their appointment was,” he said.

“All this meant that when there was an opportunity to drop it, some GPs did so.”

However, Dr Graves said that he knew of at least one clinical commissioning group that is considering reinstating payments.

He added: “I think it will reach a plateau, because some people do find it really useful. But I think that before it does that usage will decline further.”

A spokesperson for NHS Hertfordshire confirmed use of Choose and Book has fallen and is now around 35%.

She added: “Herts Valleys Clinical Commissioning Group is developing plans to address the fall in the number of referrals being made through Choose and Book.”

A boycott of Choose and Book has also been mentioned as a possible target for inclusion in the BMA’s forthcoming ballot on industrial action over pensions.

The DH spokesperson said that despite the fall in the percentage of referrals being made through Choose and Book, the number of patients handled by the service continues to rise.

An average of about 500,000 patient referrals are being made from GP practices to first outpatient services via the service each month.

In addition, more than 150,000 referrals are made to other services such as Allied Health Professionals, GPs with special interests and assessment services each month.

“These activity levels demonstrate that Choose and Book works well for many thousands of people every day and can provide significant benefits to patients and the NHS,” the spokesperson said.