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At the heart of general practice since 1960

Hypertension quality points will be difficult to earn, say experts

Rob Finch gets a preview of Choose and Book to see how convenient ­ or disruptive ­ it will be in a consultation

Hardly any GPs have seen Choose and Book. Pilots of the system have been a disaster. Just 63 electronic bookings had been made at the last count, compared with a target of 205,000.

The lucky few who have seen it in action have mixed opinions. Some GPs describe it as a disaster. Others are supportive, but guarded.

The Government is now

offering GPs a £95 million bung to install the system. They also plan to include it as a 'non-optional extra' with the far more attractive practice-based commissioning.

So is it any wonder GPs are hugely sceptical about Choose and Book?

Last week Pulse was given a sneak preview of how the software will work.

How it works

The first barrier, and an early concern for GPs, is logging on. Every GP will have a smart card with a 'digital certificate' to authenticate their identity. The system will read the card and GPs will enter a password to load the software. If their card is lost or stolen, GPs will need to know what to do and whether the PCO will issue a replacement. There will be no national guidance on this.

As most GPs' computer systems cannot directly link with Choose and Book ­ and still won't be able to by the end of the year ­ the system will appear as an icon at the bottom of their screen. If a patient needs to be referred, GPs will have to click on the icon to open Choose and Book.

Before doing so, however, they will have to note the patient's NHS number from their computer record. This is inserted into a field at the top of the first Choose and Book screen. The system will fill in the rest of the patient's details using a national database.

When, and if, GP computer systems and Choose and Book can link up, this data will be taken from the patient's re-cord automatically.

Next, GPs have to navigate a series of drop-down menus and tick-boxes to find the choice of clinics. Here the software designers have exercised some common-sense.

The first choice for GPs will be the 'treatment function' the patient needs. This is essentially the specialty, but the wider definition allows for referrals to GPwSIs or tertiary referrals within hospitals. GPs then have to choose the specific clinic type and sub-specialty.

Lastly, GPs must state whether the referral is two-week, urgent or routine. Any GP who is vaguely familiar with using a computer will find these stages fairly easy and, after a brief period of familiarisation, should be able to whizz through them.

Once this information has been entered, Choose and Book offers the required five options of clinics, showing the distance from the patient's home and the physicians' names. Each option has been verified by the local PCT as being of a good enough quality to be included.

Other choices available at this stage include whether to nominate an individual doctor, for example male or female, or the entire pool of doctors at the clinic. Alas, the system does not allow you to avoid a particular specialist.

It is at this point that perhaps the most reassuring aspect of Choose and Book emerges ­ GPs do not have to make the booking. They can send the patient away with a printout of the five choices, which is an 'entitlement to book', and tell them to sort out an appointment to suit them.

This can either be done at reception, if the receptionist also has access to the system, or via a booking hotline.

GPs will know, though, that this will not satisfy some patients and they will have to go further down the line.

Each of the five clinics offers a choice of available slots which the GP can book.

Each option also gives information about what routine investigations and procedures the clinic can do, as well as investigations needed before the appointment. GPs can also write a referral letter to send with the patient's details.

Our verdict

If GPs do book the appointment, there is no doubt it will take a few minutes. Certainly far more than the one minute estimated by the Government. Questions also remain over confidentiality and the time-table. But Choose and Book could be a useful tool and the software is more user-friendly than expected.

'I'm somewhat reassured'

Dr David Jenner said the briefing had answered some of his concerns and he was happy he would not actually have to book the appointment in the consultation. But he was still sceptical about whether the IT would work and about the timescale.

'This presentation was somewhat reassuring. The biggest barrier is winning over the opinion of the doctors. The whole thing needs a beta test for six months. especially in some sceptical practices ­ I've offered mine.

We need to see the system working in vivo rather than in vitro. They are saying December but the reality is most likely to be by the end of next year.'

Dr David Jenner is a GP in Cullompton

and PEC chair

of mid-Devon

PCT

'Nothing has changed'

Dr Williams said the demonstration does not answer many of GPs' fundamental concerns over whether offering choice improves outcomes and says doctors have still not been adequately consulted.

'This is not tackling the highest priority in the health system or solving the problems patients have. If I was a patient offered a choice I'd like to see how good the outcomes were and that information isn't there. There has been so much disinformation there is little to base a clear judgment of the scheme on.'

Dr John Williams is a GP in Guildford, Surrey, and joint-chair of the

joint RCGP/GPC

IT committee

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