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England's Choose and Book IT programme, designed to link more than 30,000 GPs to almost 300 hospitals across the UK, is at a crossroads. It was delivered on time in 2004, and in February the Department of Health renewed Atos Origin's contract to supply the system, in a deal worth about £65m over two years.
The system, which allows patients to book the time and date of an appointment from a GP's referral with a hospital or clinic, was used for 57% of all appointments made by GPs in February, far fewer than the government's forecast of 90% by March 2007.
Some areas of the country have exceeded 90% usage, but in other places the system is used for a small minority of bookings. Figures released by the Department for Health in March show that, while Barnsley PCT runs 95% of GP referrals through Choose and Book, Leeds PCT uses it for just 20%. The latter trust declined to comment on why this should be so.
In February health minister Ben Bradshaw commented: "The most important ingredient in all this is local leadership. Those two health communities are separated only by the M1 motorway. The system is no less available in Leeds than in Barnsley." Quoting the figures, he said: "The critical factor is the leadership in Barnsley, where the acute trust has really engaged and got behind Choose and Book."
Barnsley PCT is pleased with its progress: it cites a MORI figures showing that 57% of its patients were able to recall being offered choice by their GP compared to a national average of 46% during 2008. Stuart Smith, the trust's commissioning manager, said he is pleased to see that patients are recognising their freedom of choice and selecting services in the area, and that the NHS funding system will push poorly performing hospitals to raise their standards to attract more patients.
But even in Barnsley the scheme was not always so popular. During trials in 2005, the PCT reported that the system was so cumbersome that it had been shunned by doctors, unimpressed that there was no funding for staff training. It took until the summer of 2006 before GP staff training facilities were available in the area.
A 2005 report to the South Yorkshire Strategic Health Authority revealed a "general slowness" of the system had led to a resistance among staff. GPs and consultants went on record as being concerned "in terms of clinical safety" and it had taken four minutes to make a booking which should take a matter of seconds.
Harbouring problems
Plymouth has been more successful than most areas in introducing the system – but it also reveals the strains. Neil Parsons, the Choose and Book programme leader for Plymouth PCT, has said that 44 out of 45 GP practices in the city are now using it, with 70% to 80% of referrals to consultants being handled by the scheme online or by phone. This has resulted in a reduction in waiting times for an appointment from 13 weeks to five.
But according to Plymouth City Council's Health and Wellbeing Overview and Scrutiny panel, results from the service are not so great. Councillor Joan Watkins, a Conservative member for the Stoke area of Plymouth, said the programme sounds very good but the scheme did not work when she used it.
She said she called three times and was told Derriford Hospital had not made any appointment times available, her GP also had no time for the new system, she was asked to complete a feedback form before she had managed to use the system.
Councillor Tom Browne for the Southway area of Plymouth claims to have been trying to make an appointment using Choose and Book since last November. People, he says, do not call you back.
Paul Cooper, of the Plymouth Hospitals NHS Trust, has told councillors there are now about 100,000 referrals using Choose and Book each year. "If you log on to the appointments online it works well, but if you don't get in and have to go into the phone cycle that's where the problems come," he says, adding that some Plymouth GPs have been resistant to using the new system.
In Lincolnshire, which had 40% of appointments running through Choose and Book in December, the PCT's director of strategic planning has gone on record as saying that GP resistance is holding back Choose and Book. Dr Martin McShane told a meeting of Lincolnshire PCT's health scrutiny committee last year that, whilst 90% of GP surgeries have the IT systems in place for the scheme, only 40% of appointments were being made electronically.
"There is antipathy towards the system in Lincolnshire and we need to get GPs on board and align it with their professional standards and principles," he told the committee. "The system had its teething problems and is still not good enough, yet but we are working extremely hard to make it good enough," he added.
MPs, who are impatient about much of the whole National Programme for IT, are extending this to Choose and Book. Parliament's Public Accounts Committee (PAC) has warned that, unless the Choose and Book scheme shows signs of moving forward nationally by this July, PCTs will be allowed to scrap the programme locally.
Edward Leigh, the committee's chairman, has said that health trusts should not be expected to deploy systems that are not working properly. And, he says, if there is no improvement to this situation within six months, then the Department for Health should consider allowing trusts to apply for funding for alternative systems.
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