Incentive money for Choose and Book may be spent on upgrading hardware to allow e-booking to work, as primary care trusts face bills of hundreds of thousands of pounds to bring systems up to scratch.

Newcastle PCT estimates that it will have to replace around 400 PCs, while other PCTs say that more than half the servers in their practices may need replacing to operate the e-booking software.

GP practices had hoped that the £95 million incentive money, the first wave of which includes an average payment to PCTs of £6,000 per practice if they meet the Department of Health’s implementation targets, would go to help ease the initial staff costs of implementing the new system.

However, it now looks likely that at least some PCTs will be forced to spend the money on machines rather than people.

A report to Newcastle PCT’s March board meeting by Ian Davison, head of IM&T, said that an additional capital sum of £265,000 will be needed in 2005-6 to replace 400 PCs so that the PCT and practices meet the NPfIT minimum specification needed to access NPfIT applications including Choose and Book.

The report says that funding for all its additional capital funding needed could be found for a variety of sources but adds: "NPfIT funds could also be utilised e.g. Choose & Book incentive fund (particularly for replacement of hundreds of PCs in GP practices)."

A spokesman for Newcastle PCT told EHI Primary Care that the PCT is currently undertaking an audit of its existing hardware and soft ware.

She added: "From this we hope to get a picture of what our further IT requirements are and to feed this in to our overall rolling replacement programme that all PCTs are required to do and this will support our Choose and Book requirements."

A London PCT IT director told EHI Primary Care that he was trying to find out whether his practices needed to have Windows 2003 servers for the messaging system to work. He already has plans to replace Windows NT servers in almost half the practices in his PCT but problems could be faced if all the practices in his area had to be brought up to scratch by the end of the year.

He said: "We have been trying to get a definitive response from the National Programme for IT (Connecting for Health) about what the minimum specification is for the Choose and Book messaging but we haven’t had an answer yet.

"If it will work on Windows NT then we can take a risk and replace 30 this year and the rest next year. If we had to finance the replacement all in one go there would be cost pressures and it brings into question the use of Choose and Book incentive money."

He said his PCT’s situation was probably typical across England and questioned whether GP clinical system suppliers would be able to cope with the task of replacing such large numbers of servers.

Sean Riddell, deputy managing director of EMIS, said Choose and Book would not work on EMIS systems using Windows NT and that there were approximately 600 practices still using NT servers out of EMIS’ client base of 5,500 practices.

He told EHI Primary Care: "PCTs are waiting for central guidance on what will be reimburseable on the hardware side. If there is central funding I am sure PCTs will start increasing the number of PC and servers upgrades but if there isn’t then they are telling us that they don’t have an awful lot of money in their base budgets."

Dr Paul Cundy, a Wimbledon GP and chairman of the British Medical Association’s General Practitioner Committee IT sub-committee, said the fear that Choose and Book incentive money would be spent on upgrading PCs and servers had been raised at the last GPC meeting.

He added: "There was a general concern about the lack of understanding of where this money is going. Some PCTs are suggesting that the £6,000 per practice is to pay for the hardware for Choose and Book but you can get workstations for £200 each."

The incentive money was announced by John Reid, then health secretary, in January this year on the same day a National Audit Office report concluded that the government would fail to meet its target of offering choice to every patient by the end of 2005 because of technical problems, delays in delivering upgrades and failure to engage GPs in the roll-out of Choose and Book.

The incentive money is available in three stages. The first payment, equivalent to £6,000 per avregae practice in a PCT, will be made if PCTs have agreed commissioning rules for all types of consultant putpatient referrals, if information about all providers’ services is loaded onto the Directory of Services and if at least 30 per cent opf Gps are NpfIT registered so that they can use Choose and Book.

The second stage is a capital payment of £100,000 if 50 per cent of monthly referrals are made using Choose and Book by the end of October and a final payment of £100,000 will be made if 90 per cent of referrals are made using Choose and Book by the end of 2006.

Last month the Department of Health issued a reminder about the incentive scheme in its weekly bulletin to chief executives.

The bulletin said: "The deadline for the first stage of the Choose and Book PCT incentive scheme is closing quickly. To qualify for the first payment under the scheme, PCTs must – by the end of June 2005 – have commissioning rules in place for all their referrals, ensured that providers have completed the Directory of Services, and registered at least 30% of their GPs. With many PCTs having yet to set up their Registration Authority, time is running out to meet the third of these criteria."

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