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PCTs turn screw on GPs over Choose and Book

By Steve Nowottny

PCTs across England with low take-ups of Choose and Book are stepping up the pressure on GPs to use the controversial referral system, Pulse has learned.

PCTs are adopting a 'carrot and stick' approach, suggesting in some cases that PMS contracts could be reviewed if GPs do not sign up.

Bath and North East Somerset PCT, which has one of the lowest take-up rates in the country, has sent two letters to GPs in the past month urging them to use Choose and Book. The second letter, from the PCT's professional executive committee, warned: 'PCTs have even been advised by the Department of Heath to serve notice on PMS contracts and move all PMS practices to nGMS contracts.'

Although the letter later said this was not an option the PCT was considering, GPs in Bath – all of whom are on PMS contracts – said it had provoked 'considerable anger'.' It explicitly says they're not thinking about it – but of course they are,' said Dr Jonathan Hamling, a GP in Bath and member of Avon LMC. 'We understand the pressure on the PCT is immense from the centre, but we'd like a little more carrot and a little less stick.'

A spokesperson for Bath and North East Somerset PCT admitted the letter had been 'inadvertently misleading'. 'The department has not advised us to serve notice on PMS contracts but has made it clear that as PMS is locally negotiated this is an option for the PCT,' she said.

In Suffolk, currently bottom of the national rankings for Choose and Book, a letter from Dr Andrew Hassan, a GP in Hopton and co-chair of the professional executive committee, warned GPs: 'Our failing performance in both choice and Choose and Book is unfair to patients and compromises our service significantly.'

Mr Bill Robinson, lay chief executive of Suffolk LMC, said mandatory use of Choose and Book would not be part of the continuing negotiations over PMS contracts in Suffolk. 'There certainly isn't any requirement in the new PMS contract negotiations to undertake Choose and Book,' he said. 'We've always spoken long and hard to the PCT about the potential problems of trying to force anything on the general practitioners relating to this scheme.'

Elsewhere, PCTs are taking a range of approaches to increase use of Choose and Book. Haringey PCT plans to develop 'individual practice action plans' with low-usage practices. Sefton PCT, which offers a local enhanced service for Choose and Book, is to meet all GPs in its area to push the initiative, despite strong local opposition.

Dr Andrew Mimnagh, chair of Sefton LMC, said: 'It's a mixture of carrot and the implied shadow of a stick. I suspect something's come straight down from the top. I suspect they've been given a "get it working – or else" message.'

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