The target for 90% of referrals to be made through Choose and Book is to remain for the NHS, even though the latest deadline has been missed by some way.

Final figures are not yet available for use of Choose and Book to March 31, but it is clear the NHS will have fallen well short of the 90% mark which was one of six key targets set by the Department of Health for 2006/67.

Statistics seen by EHI Primary Care for the week ending March 22nd suggest the figure was then closer to 40%, with the highest number of bookings, 909774, made by GPs in the North West and West Midlands cluster.

According to NHS Connecting for Health officials approximately 16,000 Choose and Book appointments are being made a day.

In an interview with EHI Primary Care, Dr Mark Davies, CfH’s medical director for Choose and Book, said the picture was very variable around the country.

He said: “Some PCTs will meet the 90% target, there are a significant number in the 50-80% bracket where the majority of referrals are going through Choose and Book and some PCTs are struggling with this. The point is that whatever the national figure is there are 150 stories out there and it’s very different from one PCT to another.”

However Dr Davies said despite the variable performance the 90% target would remain.

He added: “The target isn’t going away. The 90% target is still there and we would expect the NHS to work towards it as soon as possible.”

Dr Davies said almost 2,500,000 million patients have now had referrals made using Choose and Book and he claimed they were the best advocates for the e-booking system.

He said: “There are areas that have made it work and in those areas its adding real benefits to patients and clinicians.”

Dr Davies said the reasons why all areas had not performed as well as some were “complicated” but in some cases he put it down to the strength of performance of the local health economy.

He added: “There are local health economies who have a track record of doing things well whether you look at their financial balance or their waiting times or what they have done in terms of primary to secondary care liaison and they tend to be areas that also have a higher utilisation of Choose and Book.”

Unhappiness over their 0% pay rise plus uncertainty over the future of any incentive funding for Choose and Book has led some GP practices to consider abandoning Choose and Book although the British Medical Association’s General Practitioner Committee decided last month to leave it to individual practices to decide what to do.

Dr Davies said it was difficult to say what impact that might have but claimed there was general support for e-booking.

He added: “When I talk to clinicians, GPs and consultants, they are entirely bought-in to the principle of electronic referral and are starting to see the benefits of electronic referral and do not want to lose that.”

Dr Davies said the Choose and Book team had a good relationship with the BMA and the BMA wanted to see Choose and Book work. Last month EHI Primary Care revealed that the BMA had decided not to publish the results of its own survey on Choose and Book (link: which found widespread opposition to the scheme among doctors.

Dr Davies told EHI Primary Care that it was not yet possible to say what would happen about future incentive payments for Choose and Book since that was still wrapped up in wider GP contract talks.

Dr Davies said one of the frustrations for the team with Choose and Book was that although national statistics showed a fast and reliable system that was not always the experience on the ground.

He added: “We know that we have a good robust system but the experience of individual users can be that it is very slow and unreliable and clunky.”

To tackle this Dr Davies said the Choose and Book team had begun to publish some benchmarks for Choose and Book on NHSnet showing the average response GPs should expect, for example data from the system shows that almost all bookings are made within 60 seconds (excluding log-in).

Dr Davies added: “You can look at what the averages are and then go back to your PCT and say ‘why am I not getting what I should be getting in terms of response times’.”

He said the Choose and Book team were working on a series of expansions to the e-booking system to enable e-booking for a range of non-consultant services such as physiotherapy, dietetics, diagnostics and GPs with a Special Interest. Pilots to enable e-booking for mental health services are already underway.