New NHS referral system cost £3m for 63 bookings

A Government strategy to allow NHS patients to be treated in a hospital of their choice is in disarray because of opposition from family doctors and delays to the computer system, an independent watchdog says today.

A Government strategy to allow NHS patients to be treated in a hospital of their choice is in disarray because of opposition from family doctors and delays to the computer system, an independent watchdog says today.

Only 63 live electronic bookings, out of 9 million referrals and against a target of 205,000, had been made by GPs up to the end of last year, six months after the new system was launched, the National Audit Office revealed. Each booking cost an average of £52,000. John Reid, the Health Secretary, made extending patient choice the centrepiece of his plans to modernise the NHS, backed by an airline-style booking system introduced last July.

In a speech to the Local Governance Network today he will say that surveys show almost four-fifths of the public want the NHS to treat them more like customers.

But an NAO survey of 1,500 GPs found that half knew very little about the plans to extend choice and 60 per cent felt "negative to some degree". Doctors complained about being treated as travel agents, answering questions about whether hospitals had car parks, and 90 per cent feared it would extend consultations, officials said.

Paul Cundy, a GP in London, said that he thought the scheme was unworkable. "When I refer a patient now, I discuss which hospital they want to be treated in, they usually accept my recommendation, I dictate a letter, I check it after it is typed and it is all done in a few minutes after the end of surgery.

"But with the electronic booking system there are 20 steps before I can start a discussion with the patient. I can only put in a request for an appointment, which is not confirmed, and it has to be done during the consultation."

Dr Cundy, who is also a spokesman for the British Medical Association on computing, added: "It is a joke in rural parts of the country, where there is only one hospital and the next one is 50 miles away."

More than one in four primary care trusts predict they will be unable to implement choice by the target date of December 2005 and only 60 per cent to 70 per cent of the NHS expects to have the computer booking system in place, the NAO said.

Edward Leigh, chairman of the Commons Public Accounts Committee, said: "Nothing short of an easy-to-use, fully functioning electronic booking system will persuade [GPs] that choice has a future."

Under the plans, patients will be given a choice of four or five hospitals, including one from the private sector, during their consultation with the GP and offered an appointment on the spot.

The NAO warned that choice "cannot be delivered without support from GPs "and without the electronic booking system fully in place. The health department faced "significant risks" in hitting its target, it said.

The electronic booking system costs £694,000 a month to run and from 2006/07 it was expected to cost £122m a year, offset against administrating savings of £71m as well as reducing missed appointments which cost £100m a year. Set-up costs over five years are £196m.

Sir John Bourn, head of the NAO, said: "The Department of Health must take urgent action to inform and engage with GPs about the new arrangements."