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The health secretary John Reid has announced a £95m "reward" scheme which can be used to pay doctors as an incentive to use new electronic booking systems.
The Department of Health wants GPs in England to use new systems to offer their patients a choice of hospitals when they need an appointment, at a time and date to suit them. The e-booking systems are a key component in the government's multibillion-pound national programme for IT (NPfIT) in the NHS.
The government has set a deadline of December 2005 for the Choose and Book programme to be in place but the roll-out of the systems to support it is running late at some trusts, a report by the National Audit Office revealed last week. This is partly because many GPs are unwilling to use e-booking systems.
The new money promised by Reid would amount to about £3,100 per doctor if distributed equally to England's 30,000 GPs.
A spokesman for the Department of Health confirmed to Computer Weekly that the money could be allocated to pay GPs who install e-booking software, use it in earnest by the end of October this year, and later book nearly all their appointments through the system.
It is rare for government to introduce schemes in which people can be financially rewarded for using systems they may otherwise avoid.
In a survey of 1,500 GPs commissioned by the National Audit Office, 61% had a negative view of the department's choice plans, and 90% thought the scheme would increase their workload.
"Even among those who said they knew a lot about it [the choice scheme], two-thirds said they were very or a little negative," said Chris Shapcott, director of health value-for-money studies at the NAO.
The NAO survey also found that more than 90% of GPs had not had an opportunity to feed into consultations for the choice scheme.
But in a letter last month to Tory MP and former GP Andrew Murrison, the health minister John Hutton said, "I am constantly surprised by the weight of criticism the national programme attracts about lack of consultation. Consultation and dialogue with clinical and other professional representative groups has in fact characterised the national programme from the outset." He accepted that communications have not always been handled "as well as we might have liked".
Extra money could overcome the resistance of some GPs, said Paul Cundy, a doctor and GP IT representative at the British Medical Association. But he added that "throwing money at GPs" would not address the problem of the e-booking system being too cumbersome to be useable, nor would it overcome the resistance among some consultants to using it.
Meanwhile, there is continued confusion among doctors and IT professionals in the NHS over key deadlines for e-booking systems. Various documents published by the department have said the target is to deliver 100% of e-booking systems by the end of December 2005. But Reid said the target is to deliver only 60% to 70% of systems by then.
A spokesman for the Department of Health welcomed the NAO report. "We have implemented the choice IT programme in stages. First we procured the equipment, second we made sure it worked, now the challenge is to roll out the service across the NHS. That is why since the autumn, as planned, we have intensified our efforts to engage with GPs," he said.
Full NAO report
Full Health Department response
www.dh.gov.uk (press releases)