Primary care trusts are being encouraged to dismantle referral management centres that handle Choose and Book so that the work can be carried out in general practice.
Some referral management centres or clinical assessment services (CAS) currently handle the entire Choose and Book process including discussing choice options and generating the password required for Choose and Book.
Dr Mark Davies, Connecting for Health’s primary care medical director, said such centres were not meeting the minimum service criteria for Choose and Book or offering a service that was in line with the new directed enhanced service for choice and booking introduced as part of the revised nGMS contract.
He told EHI Primary Care: “We are trying to incentivise the referral into specialist services electronically and these clinical assessment services are breaking the weak link in the chain. Some of the way these services are set up is not in line with the minimum service criteria and the DES has brought that into sharp relief.”
Dr Davies said one of the concerns with clinical assessment services that handled the entire Choose and Book process was that, as well as being incompatible with the DES, the services added an inherent delay for patients between the GP making the referral and the hospital receiving it. It also meant the conversation about choice was not happening in practices.
He added: “I think clinical assessment services have been a useful interim step and a lot of trusts are now naturally moving their CAS towards a more end to end process.”
While some primary care trusts (PCTs) have disentangled Choose and Book from referral management centres others are still some way off doing so. In Oxfordshire the PCTs set up a Clinical Advice and Liaison Service (CALS) in December last year to act as the central point for all elective outpatient referrals from GPs and to provide the mechanism for offering choice and making Choose and Book referrals.
A paper to the March board meeting of south west and south east Oxfordshire PCTs points out that this means that Oxfordshire PCTs do not meet two requirements of the national Choose and Book model which is that patients leave the practice with a CAB generated password and appointment request or that patients leave the practice with an appointment or written information about what to do next to make their booking.
The report adds: “However, Thames Valley Health Authority (TVHA) continues to support the current Oxfordshire model, in the light of the ongoing financial position and the perceived benefits of CALS. We are therefore continuing with our current model for the immediate future.”
The report continues that the longer term plan is to move towards use of Choose and Book within practices once practice-based commissioning has developed more fully in supporting practice-based triage and demand management models.
The report adds: “Local discussions are still ongoing with the LMC regarding our approach to implementing this DES in the context of CALS, the development of Practice Based Commissioning, and the challenging financial environment in Oxfordshire. Payment of the DES will result in a cost pressure to the system in both 2006/7 and 2007/8 due to the phased nature of payments.”
In Avon, an area where GPs have remained almost universally opposed to Choose and Book, the local medical committee said use of a referral management centre would be one of its preferred options.