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The UK Department of Heath (DoH) will miss the December 2005 deadline set for the roll-out of its Patient Choice electronic referrals system if it does not address low levels of GP support, the National Audit Office (NAO) has warned.

Other threats to the project include problems with the IT system underpinning the project, and a rapidly approaching deadline, and slipping targets. As things stand, around 30 per cent of the country will not have access to e-bookings by the deadline, NAO officials told the press this week.

GPs refer 9.4m British residents to specialists every year. The Choose and Book system is supposed to give patients more control over when and where they are treated.

The roll-out of the e-booking system is well behind schedule, a fact clearly illustrated by the DoH's performance against its own targets. The department said it planned to have 22 hospitals signed up to the system by now. In fact, there are just seven institutions that are fully compliant. The DoH expected over 200,000 e-bookings would have been made by the end of 2004. The actual figure was 63 referrals. And no, we didn't miss any zeros off the end of that number.

This is because of an intermittent fault with user authentication - NAO officials said that this problem is now all but solved - a reluctance of GPs to engage with the system and the fact that the system is not as widely available as anticipated at this stage.

News that yet another government IT project is facing difficulties will no doubt prompt a few raised eyebrows among Register readers. In this case, there is no suggestion that the supplier has not met the conditions of the contract. Indeed, quite the opposite - the NAO stressed that Atos Origin has fulfilled its contract, and has been paid.

The central system itself works perfectly well, officials said, but at the moment, GPs and hospitals can't connect to it. Instead, manual alternatives to e-booking are being implemented as interim solutions.

Confused contract

How did this happen? Well, the contract for the central booking system did not require that it be integrated with the GPs and hospitals it is supposed to connect. This is dependent on GPs upgrading their systems on a local level, as part of the National Programme for IT (NPfIT). For this reason, the NAO said, it does not expect GP compliance to rise above 90 per cent.

"We are not criticising the Department of Health," said Chris Shapcott, NAO director of health value-for-money studies, said. "We are highlighting it as an issue they need to address, very vigorously, if they are to meet their target."

When pressed, however, Shapcott acknowledged that responsibility for any problems with organisation and co-ordination did stem from the department of health and the NPfIT.

The lack of support from GPs is attributed to the DoH's deliberate strategy of withholding information during the planning stages, so that GPs could be shown a working final product rather than a pipe-dream. However, even among GPs who are familiar with the project, two-thirds report negative feelings about its implementation. The NAO said that steps have been taken to address this problem.

It's not all doom and gloom, however. The NAO stressed that this is a progress report, not a final conclusion. There is still a year to go, and the DoH should still meet its deadline if it follows the main recommendations of the report:

  • Address the lack of GP support
  • Ensure that interim solutions don't distract from deploying the full e-booking system
  • Accelerate the roll out of either the full system or interim solutions

The NOA's full report, Patient Choice at the Point of Patient Referral, is available here. ®

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NPfIT must win medical hearts and minds
BMA tells doctors: avoid NPfIT's flagship project
BMA calls warning on NHS IT

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