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King's Fund backs Government plans for major overhaul of Choose and Book

By Ian Quinn

Plans for a major overhaul of the controversial Choose and Book system by the new coalition Government have been backed by a King's Fund report which says it has failed to bring about the planned revolution in patient choice.

The study, led by Anna Dixon, the influential think tank's director of policy, finds that although the system has the theoretical potential to generate improvements, in practice the story has been very different.

A raft of issues are highlighted, including major GP resistance due to workload and not being able to refer to named consultants, chaos with the chosen IT system and the inflexibility of a system imposed from the top down.

The report includes evidence from the Audit Commission, the National Audit Office and the BMA as well as Connecting for Health, and comes as huge uncertainty hangs over the future of the system, with it targeted by both the Conservatives and the Liberal Democrats for a major overhaul.

The King's Fund warned the ‘policy ambitions for patient choice may not be realised' unless barriers to success, notably the issues impacting on GPs, are removed.

The raft of problems it cites include:

• inadequate consultation with GPs about implementation, with 78% either negative or very negative about it

• GPs reporting being plagued by system crashes, making it impossible to process appointment requests and extending consultation times

• administrative staff with poor clinical knowledge leading to referrals to the wrong clinics

• consultants claiming Choose and Book referral letters are of lower quality than written referrals

The report also compared the UK system unfavourably with a Dutch electronic booking system, and concluded: 'In England, Choose and Book, like other aspects of the National Programme for IT has been implemented as a top–down policy led by the Department of Health. In contrast, in the Netherlands the use of a booking system is a local corporate decision system.'

‘In the Netherlands, implementation at the local level means that the system has been more flexible to respond to the concerns of professionals and local providers and more easily adaptable than the national programme in England.'

Moving to more localised IT systems has been a key Conservative policy, with both the Conservative and Liberal Democrat manifestos pledging to overhaul Choose and Book.

The King's Fund report also claimed there is ‘little firm published evidence' to back Department of Health claims that Choose and Book has brought down patients' DNA rates.

A spokesperson for the Department of Health said: ‘We appreciate that various things were said in both the party's manifestos about Choose and Book, but decisions have not yet been taken by ministers about what the future policies will be.'

The King's Fund report is published in Health Economics, Policy and Law by Cambridge University Press.

The King's Fund report found that while Choose and Book has the theoretical potential to generate improvements, in practice the story has been very different The King's Fund report found that while Choose and Book has the theoretical potential to generate improvements, in practice the story has been very different

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