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GPs will soon wonder how they managed before Choose and Book ­ according to the project's chief clinician. Ian Cameron investigates

Mobile phones, electric toothbrushes, breadmakers and online banking ­ we each have favourite bits of technology that make our lives easier.

One that Professor Michael Thick believes every GP will soon add to their list is Choose and Book.

The problem for Professor Thick, chief clinician for the Choose and Book project, is that at the moment GPs believe it should be consigned to the same technological graveyard as the Sinclair C5 and the Betamax video.

The first major project of the £6.2 billion National Programme for IT, Choose and Book has been dogged by concerns over security and confidentiality. Crucially, GPs are convinced that having to take patients through a choice of five hospitals and potentially book their appointment in a consultation will create a huge extra workload burden.

GPs have variously labelled the policy an 'election-touting gimmick' and 'an irrelevance' and said it would turn them into 'glorified travel agents'.

With the National Audit Office also producing a scathing report on the programme, including a headline finding that just 65 electronic bookings had been made by the end of 2004 out of a target of 205,000, Professor Thick has his work cut out to turn the tide of opinion.

He says that an increase in the number of bookings ­ now up to 125 at last count ­ will do most to convince people that the system can work.

He also admits a degree of frustration that GPs simply do not believe his assurances about the software. 'When we dem-onstrate it works people are no longer sceptical,' he says.

'If I get disappointed it's because we are repeatedly asked the same questions and the word has not got out.'

Among the messages he says are not getting through is that most patients will not use up valuable consultation time deliberating where and when to see a consultant. Instead he believes they will usually take away a reference number ­ an 'entitlement to a referral' ­ and decide in their own time when to have their appointment. Generating the reference number takes 'just seconds', Professor Thick says.

'It seems improbable that a patient and doctor can decide the date and time on the spot. People will want to consult with family and work. When you decide a referral is appropriate you create a unique booking reference number that they can take out without the referral or booking having been done. You can get to that in 20 seconds.'

Professor Thick believes patients will also use information sources away from the surgery, including PCT advisers and the website, for details about hospital waiting times, travel, canteen facilities, shops and, later on, clinical outcomes.

Actual bookings can be made without reference to GPs or their staff, as patients can contact a national call centre or go online.

If a patient does want to go through the whole process during a consultation, Professor Thick sticks to the claims hotly refuted by GPs that this will take only a minute. GPs will still also be free to make recommendations, including for particular consultants.

'We expect people to behave as they have been behaving,' he says. 'There's nothing to stop GPs making recommendations if the patient asks for help.'

In the long run, either method will save time for both primary and secondary care, he adds.

'The current system leaves people anxious but with this people won't feel they need to check up on it. We expect that part of GP workload to just go away.'

So if Choose and Book is such a panacea, why has this message not got through?

Despite the evident communications failure, Professor Thick insists the strategy to publicise and implement Choose and Book on a piecemeal basis, rather than in one fell swoop, is the right one.

Making the technology work first, then rolling it out incrementally, is far better than a mass release to a plethora of different clinical systems and subsequent teething problems, he says.

The plan for the months ahead is for increasing numbers of local demonstrations of the technology in the hope that support for Choose and Book will snowball. A leaflet campaign will also try to address concerns over patient confidentiality.

Professor Thick, who has been seconded from his day job as a transplant surgeon at the Freeman Hospital in Newcastle, says he understands why GPs are so wary. He says the maturity of primary care IT is one of the reasons why the rollout of Choose and Book could not be 'big bang'.

He says: 'As consultants we have always been intensely jealous of primary care IT.'

Despite the almost universal disapproval of Choose and Book among GPs, Professor Thick remains convinced he can not only win over GPs but still hit the target for all referrals to be arranged using Choose and Book by the end of this year.

'I would be disappointed if we had not got significant support in three to six months,' he says.

'I'm sure we will prevail and I bet in six months GPs will wonder how they ever lived without it.

'Once they see how it works we will find we are pushing at an open door.'

A GP's view

Most GPs impressed when they see it

Dr Mark Davies does not yet use the Choose and Book system in consultations, but he has been involved in its design and has demonstrated it to hundreds of GPs.

He says: 'I have been frustrated during my 10 years in general practice at the way we refer to secondary care. We ask patients who are often in pain or anxious to put their lives on hold while they wait for an appointment and we tell them little about what is happening to their referral while they are waiting.

'I got involved in the National Programme a year ago, and have been involved in Choose and Book's design right through from functionality to the user interface. I'm not giving some NPfIT happy talk. General practice is my world. No-one is saying this is without its challenges but this will fundamentally improve the experience of patients. Most GPs who have seen Choose and Book have been impressed.

'It is designed to be a tool to be used by a practice in a way that best meets the needs of its patients rather than something that dictates how GPs do things.

'We need to draw a distinction between the additional time in a consultation to use the software ­ which must be a matter of seconds ­ and the time required to offer choice.

'How long this takes will vary enormously from patient to patient. What is clear is that for those patients who want a longer conversation about their options, as a GP I need to hand this on to someone else as my 10-minute consultations are already over full.

'The vast majority of the actual bookings of an appointment will be made outside the consultation.

'There are many myths out there and I would really encourage GPs to make their own decisions. I've demonstrated it to hundreds of GPs and the vast majority say they can make it work.'

Mark Davies is a national clinical lead for the Choose and Book programme and a GP in Hebden Bridge, West Yorkshire

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