Exclusive: The Department of Health is investigating a shock fall in the proportion of GP referrals made through Choose and Book, including the impact of withdrawing funding to implement the change from practices.
The Government's notional target is for 90% of referrals to be made through Choose and Book, but the latest figures indicate usage has fallen from a high two years ago of 57%, to around 50% in January 2012.
The fall comes after the removal of the Choose and Book LES in many areas of the country and after a Pulse investigation suggesting the initiative was being left to ‘wither on the vine' as more than a third of trusts offering a LES removed payments in 2010/11.
The Department of Health admitted there has been falls in use in some areas and that the loss of funding could be a factor, but that they were committed to ‘embed Choose and Book into daily clinical practice'.
Many PCTs have local targets for usage of Choose and Book – in some cases for 95% of referrals - but board papers seen by Pulse reveal concern in many areas over the use of the scheme.
Choose and Book is classified as ‘failing' in a recent performance report from NHS Harrow. It slumped 9% to just over a third in November - 34% against performance last March of 43%.
Choose and Book was classified as ‘failing and worsening' in February board papers from Bristol, North Somerset and South Gloucestershire PCTs. In December, usage fell by 6.3 percentage points to 56.4% in NHS Bristol, by 11.6 percentage points to 62.4% in NHS North Somerset and by 6.3 percentage points to 65% in NHS North Gloucestershire against the previous month.
NHS Calderdale, Kirklees and Wakefield's report said Choose and Book figures were ‘stagnating' across the whole cluster and identified ‘serious deviation from target' and that ‘corrective action plan was required'.
In last month's newsletter to GPs, North Staffordshire LMC advised practices to consider going back to paper referrals following withdrawal of LES funding for Choose and Book.
Referring to the national fall, a DH spokesperson said: ‘There may be a number of reasons for this, including changes in GP funding to use Choose and Book.'
‘We are actively liaising with SHAs, PCTs and those clinical commissioning groups which are formed, in order to analyse the causes.
'Although usage has decreased in some areas, in many other areas Choose and Book usage has increased for referral of first outpatient appointments.'
‘We remain committed to working with the NHS (including GPs) to embed Choose and Book into daily clinical practice so patients can reap the rewards of greater choice and more efficient healthcare.'