The government’s targets for the implementation of Choose and Book this year look almost certain to be missed, despite being one of the health department’s key priorities.

Continuing problems with clinical engagement and delays in implementing fully integrated Choose and Book systems are two of the key issues holding back roll-out of the system according to NHS managers and doctors.

This month the British Medical Association’s General Practitioner Committee (GPC) met the Department of Health to discuss GPs’ concerns over Choose and Book.

Dr Richard Vautrey, a GPC negotiator with responsibility for IT, said the meeting had gone well but the GPC had told the DH it was ‘foolish’ to set targets for Choose and Book to be used for 50 per cent of referrals by the end of October and 80 per cent by the end of December.

Dr Vautrey told EHI Primary Care: “The October deadline is unrealistic and we cautioned them about trying to have a target that was unlikely to be achieved in any meaningful way.”

Dr Vautrey said the GPC was beginning to develop a better relationship with the DH over Choose and Book and had been told that version two of the software would be demonstrated soon. He added: “We need to see the revised software first and see whether that allays some of our fears but we also remain concerned about the workload impact on general practice.”

The Choose and Book targets have already been scaled down from the initial plans for Choose and Book to be used for all referrals for first consultant outpatient appointments by December of this year.

One of the main hurdles identified by PCTs is the lack of integrated GP systems which means GPs must instead use web-based booking options, which take more time to use than an integrated system.

Sheila Charnley, Choose and Book project manager at Morecambe Bay Health Community, predicted the October target would not be reached.

She said: “The failure of the programme to deliver compliant GP systems in line with the October target has left us adrift. The web-based or ‘naked booker’ option is not a realistic substitute. There is additional time needed to search for patients on the spine and this information may not be as up to date as the demographics held in the practice. Plus we have been working with web-based booking for years and achieved very limited interest.”

GPs are already concerned about the workload implications of Choose and Book and the web-based solution adds to the time since fields are not automatically populated with patient’s demographics from the practice system as they are with an integrated version.

Charnley said her department had recruited 11 potential early adopter practices out of a total of 57 practices in her patch but none were prepared to start booking until the integrated solution was available. She said she had already informed her SHA that her department was at risk of not meeting the target despite pressure to do so.

She added: “We’re very, very unhappy about the October target and I feel that we have been let down in terms of delivery by the programme.”

Other PCTs around the country are also alerting their SHAs to their potential problems with the October target.

At its board meeting last month Southwark PCT accepted a report from its IT department which said there were ‘many risk within the achievement of the October and December targets.”

These included IT problems outside the control of the PCT, the inclusion of dentists in the referral targets despite the fact that no dentists were connected to N3 or even NHSnet and problems with clinical engagement.

The report adds: “We can work with the early implementers to determine what the impact is for practices and what benefits there are. This will help us to ‘win over’ many practices. However this approach takes time and has no guarantees.

The LMC has also stated it does not approve of Choose and Book which links in with the national press and GPC discussions. We believe that once practices can see the software and others are using it that that they will all want to do this. The risk is doing this without a mandate by October/December 2005. What if a practice says no?”

Greater Manchester SHA said all its PCTs had indicated they did not intend to pursue web-based access for Choose and Book. However a report to the SHA board meeting says: “Given the anticipated constraints on the GP system suppliers to be able to upgrade the GP clinical systems, it has been recommended that all PCTs reconsider the alternative approach of web-based access in order to achieve incentive scheme milestones.”

One of the main problems for PCTs is that many practices need new hardware for Choose and Book to work. As reported in EHI Primary Care last month Newcastle PCT needs to replace 400 PCs at cost of £265,000 so that the PCT and practices meet the minimum specification for Connecting for Health applications, including Choose and Book.

West Gloucestershire PCT says it needs to spend £360,000 to bring IT infrastructure up to CfH standards. A report to its May board highlights the risks identified by its countywide programme board about the implementation of Choose and Book. Risks identified include a lack of clarity of NPfIT contracts with GP clinical system suppliers and services available under the contracts.

The report states: "This has serious implications for West Glos PCT needing to replace the majority of practice hardware. It also stalls local roll-out planning and hampers GP engagement."

iSOFT, suppliers of one of the three most commonly used GP systems, has yet to begin roll out its Choose and Book compliant system. An iSOFT spokesman told EHI Primary Care: “Both Premiere and Synergy have been made Choose and Book compliant and these products are currently in the final stages of NHS Connecting for Health (CFH) ‘sandpit’ testing. We expect to complete the testing cycle in July with a view to commencing rollout immediately thereafter.”

He added: “We have the capacity and are planning to deploy Choose and Book to all of our Premiere and Synergy Practices before the end of October, which accounts for approximately 85% of our total primary care user community at this time. In parallel to the Choose and Book rollout we are also migrating most of our few practices who are still running legacy systems to Synergy. Thus the overall percentage of iSOFT Practices who are Choose and Book compliant will show an increase from 85% to closer to 100% during this timeframe.”

The first target for the Choose and Book incentive money is the end of this month. In order to receive a capital payment equivalent to £6,000 per practice PCTs must have 30 per cent of GPs registered for smartcards by the end of June, to have agreed commissioning rules and loaded hospital clinics onto the Directory of Services.

Many PCTs are expected to meet this target although on June 9 CfH said that almost 3,500 GPs were so far registered users. That left about another 7,000 GPs to be registered in the next 21 days if all PCTs were to meet the target.

A spokesman for Medway PCT said it had already met the 30 per cent target and expected its neighbouring PCT, Swale, to also meet the deadline. The spokesman added: “Our progress on the October target is under constant review.”

Sean Riddell, deputy managing director of GP system supplier EMIS, said only 18 PCTs out of more than 300 in England had so far placed orders for Choose and Book software from EMIS.

He added: "The way the system is organised means that PCTs can choose to have one company for their training, another to install the software, choose to do part of it themselves and use somebody else for hardware upgrades and they will all have dependencies on each other. We don’t know how that will work until PCTs tell us what they wish to buy from us."