Government warned over patient choice pledge

19/01/05 - Health section

Government warned over patient choice pledge

Urgent action is needed if the Government is to deliver on its pledge to give patients more choice of where and when they get hospital consultations, a report warned.

The National Audit Office looked at Department of Health progress towards its target of offering every patient referred by GPs for non-emergency treatment the choice of four or five hospitals by December.

It found a tiny fraction of referrals had so far been made through the new e-booking service set up to deliver patient choice, many GPs were against the principle, and nearly a third of hospitals had no plans to implement it.

GPs' reluctance and non-compliance of IT systems in surgeries and hospitals with the £196 million central e-booking system along with an intermittent technical fault have been blamed for hampering progress.

Failure to meet targets

Out of 9.4 million non-emergency referrals, up to December last year, just 63 were booked through the NHS's new Choose And Book computerised system, rather than the hoped-for 205,000.

And the system will only be operational across between 60% and 70% of the NHS by December, NAO warned.

While acknowledging some progress had been made, the report exposed a gulf between the Department's target on patient choice and plans for implementation on the ground.

Nearly a third of Primary Care Trusts have no plans to introduce any patient choice while more than a quarter predict they will not achieve the December target, NAO found.

A survey of 1,500 GPs found that half of them knew very little about patient choice and just 6% were well versed on it, according to the report.

While most thought it will have a positive impact on patients' experience, 90% feared it will make consultations longer, increasing their workload.

And 45% of those questioned said patient choice would make health inequalities worse.

Nearly two-thirds of the doctors were either very or a little negative about patient choice.

'Providing choice will not be simple'

The report recommended the Department of Health urgently addresses the low level of GP support and consider speeding up the e-booking system.

Interim IT systems should be monitored and not affect the implementation of e-booking.

NAO head Sir John Bourn said: "Enabling patients who are referred by their GPs for hospital treatment to choose where they want to be treated promised to bring benefits to the patients themselves and to the wider NHS.

"Providing such choice will not be simple, however.

"The Department of Health must take urgent and effective action to inform and engage with GPs about the new arrangements.

"GPs' support may be hard to secure and indeed choice will be hard to deliver successfully by the end of 2005 if the electronic booking system is not largely up and running by then."

The Department of Health is tackling the problem with a campaign to inform and engage GPs.

A new National Implementation Director for Choose And Book has also been appointed.

Health Minister John Hutton said: "We welcome this report. It confirms that providing greater choice over hospital treatment will deliver very real benefits to patients.

"The report also acknowledges that Primary Care Trusts and GPs are moving in the right direction to deliver choice by the end of this year.

"Offering the choice of four or five providers for hospital referrals to patients by December 2005 is a big challenge for the NHS.

Missed appointments

"As we set out in the Department of Health document Choose And Book, published last August, this will be offered mainly through IT but also other means, such as phone booking.

"We have implemented the choice IT programme in stages. First we procured the equipment, second we made sure it worked, now the challenge is to roll out the service across the NHS.

"That is why since the autumn, as planned, we have intensified our efforts to engage with GPs. More than 2,500 GPs have already been involved in developing systems to support choice and booking, and this engagement will increase during this important next stage of implementation."

On GP support for patient choice, Dr Gillian Braunold, joint clinical lead for GPs at the National Programme for IT, said: "GPs want to enable choice and there is plenty of scope for positive engagement.

"I'm optimistic that the profession will respond positively to the choice and access agenda using both IT and other means to make it happen."

The e-booking system for GP referrals cost £196 million to set up over five years with the added annual cost of £122 million offset against administrative savings of £71 million.

It is hoped it will cut the number of missed appointments, currently costing £100 million a year.


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