The June target for referrals through Choose and Book has been scrapped to allow GP practices more time to earn the incentive money in the revised GMS contract.
The directed enhanced service (DES) for choice and booking which began in April this year set a deadline of June 2006 when practices were expected to refer 25% of patients using Choose and Book or be forced to repay their aspiration money.
However the Department of Health has agreed that repayment of the aspiration money will instead be dependent on referral rates between September and the end of February 2007. Practices will be expected to refer a minimum of 50% of referrals during that six month period to avoid repayment of the aspiration money worth £1,320 to the average practice with 5,500 patients.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s General Practitioner Committee (GPC) and its lead negotiator on IT issues, announced the decision at last week’s local medical committees’ conference where representatives passed a motion describing Choose and Book as “deeply flawed and not fit for purpose.” He told the conference: “I think Choose and Book has been the one phrase that has brought the most boos and hisses so far. But we have been listening to the concerns, particularly over the June target and have successfully negotiated the removal of that target.”
He added: “While many people are struggling with Choose and Book many others are getting it to work and we should support our colleagues who are doing so. There is no doubt that patients find it great when they can walk out of the surgery with a booked appointment in their hand.”
GP representatives have been calling for a revision of the June target after practices in some areas have struggled to get the scheme to work because of a variety of local difficulties. Dr Vautrey said the GPC negotiators would continue to work with the national Choose and Book team to resolve problems where they arose.
He also announced that the GPC would be holding a conference later in the year in conjunction with the national Choose and Book team to hear GPs’ concerns over the scheme. A date for the conference has yet to be set.
Afterwards he told EHI Primary Care that he hoped the removal of the June target would give practices more breathing space.
He added: “There are still problems with Choose and Book and we felt the removal of the June target was a very sensible way forward and the Department of Health and NHSEmployers agreed to that. Hopefully practices can now feel a bit more confident about meeting the targets and not quite so pressured to do so.”
The LMCs’ conference rejected a motion that Choose and Book should be scrapped but was critical of the scheme. Dr Barry Moyse, from Somerset LMC, told representatives that Choose and Book targets were continually missed and claimed that even enthusiasts were struggling with the scheme.
He added: “The NHS doesn’t respond to patient need by fiddling with an immature, slow and often unavailable system.”
However Dr Rachel McMahon a member of the GP registrars’ sub-committee and its representative for the Yorkshire region, told the conference that Choose and Book was a great success in her practice.
She added: “I have fewer patients coming back to me and, because of the way we have set it up in our practice, most of the work is given to the secretaries. It’s working well for me and for a number of colleagues in our locality. ”
The conference also heard almost universal criticism of the plans to use a patient survey to measure practices’ achievement of the choice element of the choice and booking DES and agreed that it was not a “sufficiently robust basis to determine practice income without objective evidence. ”
Dr Peter Gledhill from Bedfordshire told representatives: “I am happy that we should be contractually obliged to undertake surveys and take into account the results of them but I am not happy that my practice income should be subject to the pitfalls inherent in surveys.”
Dr Laurence Buckman, deputy chairman of the GPC, said that the GPC was forced into accepting the survey and promised that the GPC would do its best to influence the content of the survey questions so it was as valid as possible but described it as “an almost impossible task.”
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