Use of the new NHS e-referrals service could become mandatory for GPs, NHS England’s chief executive Sir David Nicholson has said.

NHS England is also considering an incentive and penalty system to ensure use of the online appointment booking service, which will replace Choose and Book.

The NHS e-referrals service, being developed by BJSS, is due to be in place by the end of this year and NHS England’s aim is to hit 100% paperless referrals in 2017.

In June last year, NHS England’s director of strategic systems and technology Beverley Bryant said that use of the e-referrals service would not be mandatory because the centre wants GPs to, “want to use it”.

However, speaking at a Public Accounts Committee meeting last week, Sir David signalled a turnaround on the issue.

“I think we are getting to the point, with what we have understood from the implementation of e-referrals, where we want to get a system where we can make it mandatory as we go forward,” he said.

“The question we have to ask, and to get as wide a support for it as we can, is what incentive or penalty system do we need to put in place to ensure that it works?”

Choose and Book went live in 2004 after the then-Labour government promised to introduce “airline-style booking” to the NHS. Use of the system reached an all-time high of 57% in early 2010, but has since levelled off at 50% usage for a number of years.

Sir David acknowledged that the system has not been as well used as originally planned.  

“Some people just did not like it and did not want to use it, and that is why we have gone through this process of developing the e-referrals system, which has had massive discussion among GPs, and we are still working on all that,” he said.

“They think they want a different way to do it. We have been unable to persuade them of our case.”

An NHS England spokesperson told EHI that the organisation hopes that by building a new system which is easier to use, the uptake will naturally increase. However, the spokesperson did not rule out imposing penalties on those who do not use it.

“Imposing penalties into a system like NHS e-referrals will require cooperation across health economies for it to work.  An e-referral system will also require clinic slots to be made available to encourage GPs to use it,” said the spokesperson.

“We will listen to why health economies stay wedded to paper; we will support GPs and providers to move off paper; and if we reach a tipping point where we feel there is no explainable reason why the minority aren't moving to it, then we will mandate it".

NHS England has been running a consultation on what the service should look like. Speaking at the PAC meeting, Sir David said the main difference will be that, “anyone can refer to anyone.”

“At the moment, for example, referrals can go only to named consultants or groups of consultants in a speciality,” he said.

“E-referrals allow any GP to refer—and in some circumstances allow self-referral, if that is required—to any NHS clinician. They can refer to physiotherapy, to diagnostics—to a whole series of things.”

Atos is contracted to continue to provide the Choose and Book service until the end of this year.