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Choose and Book take-up stalling

By Steve Nowottny

Take-up of Choose and Book has slowed significantly since the start of the year, Dr Stephen Miller, the programme's new medical director, admitted last week.

NHS managers are pressuring GPs to increase use of Choose and Book after figures showed only 40% of referrals were made through the system in July, up from 34% in January.

If uptake were to continue to increase at this rate it would take at least five years to reach the 90% target, originally set for March this year.

Dr Miller, a GP in south-east London who took over as medical director last month, said the target now was to reach 90% of referrals through Choose and Book ‘as soon as possible'.

‘Whether it's five months or five years really depends on so many other factors,' he said.

‘If anything, the fact that it's not progressed in the past three months as much as it has done prior to that makes me feel we have to double our efforts.'

As part of those efforts, SHAs across the country are cracking down on underperforming PCTs and practices.

Board minutes from NHS East of England warn ‘further progress must be made'. They state that the reasons for the current level of underperformance were complex and deep-seated, and that meetings with PCTs were about to take place to establish ‘robust action plans for improvement'.

Last month, Pulse reported that a number of PCTs, including Suffolk, Sefton in Lancashire and Bath and North-east Somerset, had adopted a ‘carrot and stick' approach to encourage GPs to use the system.

Dr Chaand Nagpaul, GPC negotiator, said some GPs had dropped Choose and Book due to the two-month delay in renewing the Choice and Booking DES.

‘GPs, not unreasonably, were not minded to be putting work into this process when they were not aware of any recompense,' he said. ‘I think that may to some extent account for the uptake having stalled.'

But Dr Michael Linton, a GP in Rochdale, Lancashire, said it was the PCTs themselves that were putting GPs off using Choose and Book because they were implementing it badly.

Dip in Choose and Book use?

Use of Choose and Book may actually have dipped between March and May.

Figures released by the Department of Health show that only 44% of patients recall being offered a choice of hospital for their first outpatient appointment in May either through the Choose and Book system or manually. In March the figure was 48%.

The dip coincides with a boycott of the Choice and Booking directed enhanced service (DES) by many practices in protest at the pay freeze.

Connecting for Health refused Pulse's request for detailed figures showing actual use of Choose and Book over this period.

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