Delays in implementing e-booking threaten patient choice agenda

BMJ 2005; 330 doi: (Published 20 January 2005) Cite this as: BMJ 2005;330:166
  1. Kathryn Godfrey
  1. London

    The roll-out of “e-booking,” the system that allows GPs to book hospital appointments for patients online in the surgery, has been slower than planned and threatens to thwart government targets for patient choice, says a report published this week.

    By the end of December 2004, just 63 hospital appointments had been made online, far short of the 205 000 target that the Department of Health had hoped to achieve, says the report from the National Audit Office. In addition, just seven hospitals—out of the target of 22—had fully implemented their information technology systems.

    The Department of Health needs to manage “significant risk” if it is to achieve its agenda on patient choice, says the report. In particular, the current lack of GP support for the initiative needs to be tackled.

    Targets set out in a 2002 public service agreement (the “choose and book” component of the NHS's information technology strategy) state that all patients being referred by a GP for non-emergency treatment should be offered a choice of hospital from a selection of four or five healthcare providers (including the private sector) by the end of 2005. Altogether this would mean making 9.4 million hospital appointments online each year.

    But by the end of 2005 e-booking will be available only to 60-70% of hospitals and GPs, says the report. To make sure that the NHS can deliver patient choice, without e-booking where necessary, the Department of Health needs to make interim arrangements, it adds.

    Lack of GP support and knowledge of the initiative were also major concerns of the report.

    Chris Shapcott, director of health value for money studies at the audit office, said: “Lack of GP support is potentially the most serious risk affecting the implementation of patient choice.”

    A survey conducted by the audit office of 1500 GPs found that 49% said they knew “very little” about how patient choice will be delivered. Only 3% were “very positive” about choice, with 61% saying they were “very negative” or “a little negative.”

    GPs were concerned about the impact of choice on their workload. More than eight out of 10 GPs questioned said they believed they would have to work differently, and nine out of 10 believed that patient choice would increase their overall workload. And 45% of GPs thought that increased patient choice would increase health inequalities for disadvantaged groups.

    Sir John Bourn, head of the audit office, said: “The [Department of Health] must take urgent and effective action to inform and engage with GPs about the new arrangements.

    “GPs' support may be hard to secure, and indeed choice will be hard to deliver successfully by the end of 2005 if the electronic booking system is not largely up and running by then.”

    The report also found a lack of readiness among primary care trusts. Just under a third (29%) are not planning to deliver the choice target of December 2005, with two thirds not yet having commissioned the required number of providers.

    The Department of Health is planning a campaign to inform and engage GPs about patient choice through 2005.

    Patient Choice at the Point of GP Referral can be seen at

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