The flagship Choose and Book electronic booking application will be at least a year late by the time it is rolled out across England NHS chief executive, Sir Nigel Crisp, said yesterday.

Speaking to the House of Commons public accounts committee (PAC) he said that patients would still be offered a choice of four or five providers by the end of next month, but most of the appointments would be booked manually or over the phone.

The full integrated airline-style online booking service was due to be fully operational by the end of December for 100 per cent of bookings between GPs and hospitals. Sir Nigel told the PAC the system is "running about 12 months late.”

Quoted in the Financial Times Sir Nigel said that in a few parts of the country half of all outpatient appointments were now being booked using the electronic system. "It is moving fast and we will have a much better position in two to three months time."

By the end of September only 20,000 appointments in total had been made using the system since it was introduced in 2004, compared to the annual total of 9.9 million first outpatient appointments each year.

Connecting for Health, the Department of Health (DH) agency responsible for delivering the Choose and Book system has previously denied that the target was to deliver full electronic booking across England by December 2005.

A five year contract for Choose and Book, worth £64.5 million, was awarded to SchlumbergerSema (since acquired by Atos Origin) in October 2003. Despite the low take-up of the system Atos Origin is understood to be paid the full monthly contracted fee for providing the system.

The year-plus delay in delivering Choose and Book comes despite the DH offering financial incentives to GPs to use the new system. Some £95 million in incentives were announced in January by the then health secretary John Reid.

On 27 September EHI Primary Care revealed that the DH had admitted that not a single primary care trust in England would meet either the October incentive payment target, or the December Choose and Book target. A leaked email from Margaret Edwards the DH’s director of access confirmed the delays and said PCTs and practices would instead have to rely on more conventional solutions to deliver its flagship policy on choice at referral.

While the national Choose and Book solution, delivered by Atos Origin with software provided by Cerner, is understood to work, there have been significant delays in building and implementing the interfaces to GP and hospital systems.

Technical problems have also been reported with the reliability and robustness of the Choose and Book application when running over the NHS spine, which in the integrated version of the system is used for checking patient demographics, security, user authentication and electronic messaging.

GPs have also been reluctant to use the system, due to concerns about the time it takes to make an appointment during a consultation.

In June Dr Jim Johnson, chairman of the British Medical Association criticised the government’s choice agenda and dubbed Choose and Book a “fiasco” that takes no account of how GPs and hospitals work.

In January of this year an Audit Commission report into patient choice concluded that Choose and Book would at best cover 60-70% of appointments by the end of 2005; a figure that in hindsight now looks over-optimistic. The Audit Commission report highlighted technical problems, delays in delivering upgrades and failure to engage GPs.

Sir Nigel’s statement confirms that another key element of the NHS National Programme for IT is running badly behind schedule. Implementation of the NHS Care Record Service, integrated local clinical solutions and the NHS spine are all running behind the original published timelines.

A DH spokesperson said: "The Department of Health is confident of introducing Choice at the point of referral for patients from January 2006 as we committed to do, with continually increasing numbers of patients booked electronically throughout 2006.

The spokesperson added: "We have introduced a range of support for the NHS, including financial incentives, to speed up progress in choosing and booking appointments electronically, and we are confident that the results of this support will start to show in the coming months."

"We remain confident that the roll out of Choose and Book will continue to increase and great progress is being made day by day. The number of bookings is also accelerating day by day. It is therefore too soon to speculate on the position around the turn of the year but we will provide updates of progress at regular intervals."



Choose and Book referrals top 20,000 

Every PCT to miss Choose and Book target