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GPs may face penalties for not using new-look Choose and Book for referrals

GPs may face penalties if they do not refer all their patients via the new e-referrals service due to be launched later this year, under plans being considered by NHS England.

Chief executive Sir David Nicholson admitted that managers had been ‘unable to persuade’ GPs to use Choose and Book for all referrals, but that he was considering whether to make the system mandatory after it is relaunched as a new ‘e-referrals’ site by the end of 2014.

NHS England has set its sights on getting 100% of practices using the new system by 2017 – based on flight-booking websites – and this is the first time that managers have raised the prospect of forcing GPs to use it to make referrals.

NHS England had previously said that they would prefer not to mandate the use of e-referrals and  want GPs ‘to be persuaded to use it, want to use it because they see the value of it.’

But speaking to MPs on the Public Accounts Committee this week, Sir David said they were looking at an ‘incentive stroke penalty system’ to maximise uptake.

Managers told MPs the new system will allow ‘anyone to anyone’ referrals, with GPs – and in some cases patients – able to refer to any NHS service and diagnostics.

It will be available on mobiles and will automatically update the GP record. Patients will be able to book follow-up appointments, which will be linked to ensure that they happen in a pre-determined order.

Sir David told MPs: ‘GPs, of all our clinicians across the NHS, are probably the most technically advanced. They’ve got more digital systems than almost anybody. So it’s not that they’re frightened, they just don’t like the way the system works and it affects their patients they think they don’t want different ways, and we’ve been unable to persuade them of that.’

‘But I think we’re getting to the point here, where we’ve heard from e-referrals implementation, is that we want to get a system where we can make it a mandatory system as we go forward.’

He added: ‘The question we’ve got to ask is, in a sense – to get as wide a support for it as we can – and then: What is the incentive stroke penalty system we want to put in place to ensure that it actually works?’

Dr Una O’Brien, permanent secretary at the Department of Health, said the key objectives of the new service were to reduce DNAs and allow clinics ‘to run really smoothly’.

She said: ‘So it’s trying to take the best of Choose and Book and apply it in a more modern context given what we’ve learnt about how people interact with the system.’

The e-referrals system will come into operation at the end of 2014, and is central to health secretary Jeremy Hunt’s plans to create a ‘paperless NHS’ by 2018.

The current system ‘Choose and Book’ accounts for around half of GP referrals currently being made, but this proportion has been falling of late.

Dr John Canning, a GP in Middlesbrough and a member of the GPC, said Choose and Book was useful, but GPs should not be penalised for not using it.

He said: ‘There are times you can’t find things, there are times it tells you can’t do this that or the other. So the incentive is making it work in an intuitive way, and if it works properly, works well we are then in a position to actually save because we can redeploy staff and use our resources differently and better.

‘I don’t think penalties work. It’s going back to the standard thing that we’ve done throughout the system. It is a culture of fear, and a culture of penalty, whereas good organisations work on a culture of encouragement.’

A spokesperson for NHS England told Pulse: ‘We hope that by building a new system that is easier for GPs and providers to use then uptake will increase and we have a programme of support in place, through our partners HSCIC, to help health economies to adopt Choose and Book and its successor NHS E-Referrals.’ 

‘Imposing penalties into a  system like NHS E-Referrals will require cooperation across health economies for it to work.  An e-referral system will also require  clinic slots to be made available to encourage GPs to use it.’

‘Once the new system is live we will work hard to achieve our 100% target by 2017.  We will listen to why health economies stay wedded to paper; we will support GPs and providers to move off paper; and if we reach a tipping point where we feel there is no explainable reason why the minority aren’t moving to it, then we will mandate it.’

This article was ammended on 17 February to include a comment from NHS England.