GPs will be forced to refer patients through Choose and Book or call around multiple hospitals to check appointment availability in person, under radical Government plans to extend choice of NHS services.
Practices will be expected to adopt ‘labour-intensive' alternatives if they refuse to use the controversial electronic referral service, with the Department of Health consulting on sanctions for those who refuse, in a move condemned by the GPC as ‘highly inappropriate'. The DH is even looking at giving patients direct access to Choose and Book through NHS Choices so they can book their own appointments.
The proposals are part of a wide-ranging DH initiative to force GPs to engage with the choice agenda, outlined in the Liberating the NHS: No decision about me, without me consultation published last week.
GP use of Choose and Book will be published so patients can ‘exert pressure' on practices to provide choice, while GPs will also be asked to offer patients a choice of diagnostic providers, initially for MRI scans and non-obstetric ultrasound.
The Government will also begin routinely using alternative providers to treat patients who miss the 18-week target, with pilots this year focusing on orthopaedic services and full rollout from next April.
The Government's notional target is for 90% of referrals to be made through Choose and Book, but in January Pulse revealed the DH had launched an investigation after use fell to just 50%, from a high of 57%.
The fall came after many PCTs removed LES incentives for GPs' use of the system.
In its new strategy, the DH said a ‘cultural change' was needed on choice and that it was determined to ramp up Choose and Book use.
‘We are working to maximise use of Choose and Book so that more referrals are made through it,' the DH said. ‘Where Choose and Book is not being used, formal requirements to support greater choice for patients will have to be met by alternative, potentially labour-intensive, methods.'
The DH told Pulse it would be up to GPs to find alternative ways of providing choice, but said this could include phoning round providers to check their services and sending hard-copy referral letters.
Sanctions for GPs found not to offer choice were being consulted on, a spokesperson said: ‘GP practices that don't use Choose and Book will need to make alternative arrangements to ensure people have more choice in their care. Alternatives may well create more burdens on doctors.'
GPs responded angrily, with GPC negotiator Dr Chaand Nagpaul claiming it was ‘highly erroneous' to blame GPs for not using Choose and Book: ‘The main reason they don't is it is too slow and interferes with consultations. It is inappropriate for GPs to be pursuing any "labour-intensive" approach to a choice political agenda when the priority must be time with patients.'
Dr Andrew Mimnagh, chair of Sefton LMC and a GP in Waterloo, Merseyside, said: ‘If the software actually worked, it would be used.'