Honest consultation about the practical changes needed is key to NHS e-booking success, says Paul Cundy
A day is a long time in politics, and what a day 20 January was - GPs in England ended it £95m better off. This was the sum offered by the government to incentivise their use of the Choose and Book system, the first deliverable from the NHS' national programme for IT (NPfIT).
It is difficult not to be cynical about how the government has so readily come up with this amount of money for Choose and Book when it is reluctant to pay for some minor upgrades, but then throwing money at problems is a government speciality.
The greatest irony is that I, like many other GPs, actually want a sharp and snappy electronic booking system for my desktop. In the years prior to the NPfIT the General Practitioners Committee of the British Medical Association had been working with the then NHS Information Authority on an e-booking system. In fact, it had GPs' unfettered support. So yes, e-booking is a good thing, but Choose and Book is not e-booking.
Choosing between hospitals for all but the most urban populations is a nonsense - do we expect GPs to say, "you can go to the local hospital or the one 50 miles away, about which I know nothing"?
GPs have always been aware of who is good at hips in their area, with perhaps a back-up choice, and that is what we would usually recommend to our patients - a sort of referrals equivalent of a list of website "favourites".
Denying fundamental choice
Forcing patients to make a choice from a list of five providers placed on the screen not by doctors but by Primary Care Trust contract managers seems to me to be denying the patient the far more fundamental "choice" of cutting to the chase and simply being advised by their GP. The GP is after all the patient's personal medical advocate - the only one they ever have in an increasingly fragmented NHS.
And it flies in the face of evidence from around the world, which confirms that populations with the widest choice of provider are not those with the highest satisfaction ratings. But hey ho who cares, it gets Tony Blair a round of applause at the Labour Party conference.
E-booking is good and sensible, but even my patients agree that Choose and Book is political dogma.
Despite what you might expect, on this issue the NPfIT gets my sympathy, for it is between the GPs' professional rock and the politicians' hard place. The NPfIT has the unfortunate task of delivering us a system we don't want and won't use, even after a £95m bung.
As it is currently configured with its mandatory nine, and possible 20, steps for the GP for each referral (which are unpredictable, and some patients need more than one) tagged onto the end of an already fully committed appointment, all it can ever do is delay subsequent patients and make GPs even more time pressured.
Even the keenest Choose and Book advocates agree that it takes at least five minutes to complete a session. Patients value their time with their GP and are unlikely to be impressed by our squandering it on admin that used to be done by hospital clerks.
I am keen on IT and want to salvage what we can. As a GP and a taxpayer, I do not want Choose and Book to be the most costly NHS IT failure yet. So what's to be done?
Allow NPfIT to talk honestly
The first thing is for the politicians to get off the NPfIT's back and allow it to talk honestly with GPs about the practical changes needed to make Choose and Book usable. We have a list of suggestions. This includes moving the hospital clerk's role out of practices into call centres.
Second, we need to move from enforced choosing to targeted advising, giving the patients real choice in what they prefer. Third, we need the security architectures implemented.
It is a challenging list but we are game to take it on. Choose and Book may not have been top of doctors' IT wish list - system choice and GP-to-GP transfer of electronic records are our top two - but we know we can work with the NPfIT and deliver. Look at QMas (Quality Management and Analysis System) as the example, on spec, on target, on time and in use on my desk - a stunning success for both the NPfIT and GPs.
All we really need is for the politicians to agree.
Paul Cundy is a general practitioner and GP IT representative at the British Medical Association
This was first published in February 2005