The BMA has criticised technical guidance from the Department of Health (DH) which it says explicitly links the uptake of the Choose and Book, the national electronic booking service, to the new system of practice based commissioning.

The association says: “The technical guidance explicitly links the controversial Choose and Book electronic referral system with practice based commissioning. The uptake of Choose and Book to date has been very low, with many doctors fearing the system in its present form is not workable.”

Chair of the BMA GP Committee, Dr Hamish Meldrum commented: "Linking practice based commissioning with the largely untried and untested Choose and Book proposals will act as a deterrent for practices to take on this new commissioning.”

In January, the National Audit Office reported that technical problems, delays in delivering upgrades and failure to engage GPs means the roll-out of Choose and Book, was behind schedule and, at best, would only offer 60-70% availability by the end of 2005. Since then the DH has pumped £95 million into an incentive scheme to encourage faster uptake by practices.

The GPC was generally critical of the department’s technical guidance document. Dr Meldrum said: “We believe GPs are still behind the concept of practice based commissioning but unfortunately this long awaited technical guidance is neither technical nor does it give much guidance. The government document raises more questions than it answers."

The committee says that though some information on setting default budgets is given, a lot of decision making on financial allocations will be made at local level.

Dr Meldrum said: "GP practices interested in taking on practice based commissioning will need to know how these local budgetary decisions will be made, how to work out ‘reasonable’ management costs and how you can be sure that data for monitoring practice based commissioning will be accurate."

However, Dr Meldrum praised the overall concept of practice based commissioning. "GPs are well placed to deliver practice based commissioning because they know the health needs of their patients and have ultimate responsibility for their care. While not every practice will want to take on this new role, I believe there is a large body of interest amongst the profession to make this work and deliver health benefits for their patients," he said.

EHI Primary Care has invited the DH to comment.