National Audit OfficeQuin Parker

The more GPs hear about Choose and Book, the less they like the sound of it, according to the National Audit Office’s survey in their ‘Patient Choice at the Point of Referral’ report.

While GPs who described themselves as ‘knowing very little’ about the service were generally equivocal about the prospect of its introduction (half of those surveyed), those who said they ‘knew something’ (44%) or ‘knew a lot’ (6%) had far stronger views; nearly two thirds of those surveyed described themselves as ‘very negative’ towards the system. This a problem for the National Programme for IT; as the report put it, "the key risk to the delivery of choice is the engagement of GPs."

Professor Michael Thick, medical director of Choose and Book, told assembled journalists at a press conference in November that "a relative minority [of GPs] are keen to be a bit negative" about the system. But according to the NAO, only one in five of those who said they knew something about Choose and Book felt positive.

This could be linked to a belief among GPs that the system, once implemented, would actually increase consultation time – 90% of GPs believed that the system would increase their workload. This is an opinion shared by the General Practitioners’ Committee at the British Medical Association, which described itself in a November letter to GPs as "very concerned about the workload implications of Choose and Book."

"It will be difficult for GPs to complete a Choose and Book appointment within the confines of a ten minute consultation, and we are concerned about the consequent effect on the quality of those and subsequent consultations," the letter added.

Other issues identified among GPs were how training on the new system would be paid for and carried out – 90% had concerns over this issue. Just under half of GPs believed that the introduction of Choose and Book would increase inequalities in health among the more disadvantaged members of their practice, although the NAO does acknowledge some work has been done by the DH to alleviate this; a pilot scheme is underway to analyse the effect of choice in disadvantaged communities in Trent SHA, and patient care advisers, who can guide people through the system, have been mooted.


"The Department needs urgently to address the low level of GP support for their plans for implementing choice at referral"

— National Audit Office report

Most importantly of all, 92% of those surveyed said that they haven’t been made part of the consultation process in implementing Choose and Book. This is reflected more widely in PCTs as well; 88% of trusts surveyed said there were no change management plans in place to implement the system.

There are plans to ‘engage’ GPs with the system, however these concentrate on demonstrating a working Choose and Book system – something the DH has been unable to provide as yet. So far, ‘clinical leads’ have only been given the training to demonstrate test examples.

"The Department needs urgently to address the low level of GP support for their plans for implementing choice at referral," concludes the report. They "should press on urgently with its plans for informing GPs about the implementation of choice at referral and its impact on GPs and patients."

More regular, tracking surveys by the DH of GPs views were also advocated by the report – repeating the questions asked by the NAO. There are no plans to monitor levels of engagement by the DH, and this needs to change urgently, the report argues.

Despite the opposition to the scheme, there is a small pinprick of light for the DH. A total of 91% of GPs surveyed by the Department of Health in May 2004 believed that offering patients a choice of time for their appointment would be a good idea, with 82% saying a choice of hospital would also be beneficial.

This result shows that while GPs may be supportive of the choice agenda, many are either sceptical or at best, poorly informed as to how it will be delivered. It will be the DH’s job to tap into their support of the theory before that, too, disappears.


National Audit Office
Choose and Book


Patient Choice at the Point of Referral – NAO Report [PDF, 891K]

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NAO finds Choose and Book running late (E-Health Insider)