When Margaret Thatcher needed an operation in 1986, she chose to go private. Her justification? She wanted to be treated in a hospital of her choice by a doctor, and at a time, of her choice. Now the Government wants to offer as good a service to NHS patients. The ambition is admirable but, to judge by early results, progress has been disappointingly slow. The new “choose and book” system, part of the giant NHS computer network, is supposed by the end of this year to offer patients a choice of four or five hospitals, and the opportunity to book the date and time of their outpatient appointment from their GP’s surgery. Instead of the GP choosing the hospital, writing a referral letter, waiting several weeks for a reply and then contacting the patient (who may then find the date and time inconvenient), the arrangement can be made in five minutes at the click of a mouse.

The trouble is, “choose and book” has not worked out like that. A National Audit Office (NAO) report on patient choice, published today, finds that while the Department of Health had estimated that there would be some 205,000 bookings through the new system by December 2004, the actual figure was just 63. That figure is not a printing error. Another startling figure is that this malfunctioning system has cost £196 millionm for the basic infrastructure alone. These are, admittedly, early days, but the results are still astoundingly poor. The causes seem to be partly technical and partly psychological. First, the system itself is not yet complete. Many GPs’ computers are not compatible and many hospital specialties are not yet configured to receive e-bookings. Moreover, an intermittent fault with authentication has prevented some GPs gaining access to the system. During the course of the year, it is hoped, the technology will begin to work smoothly.

The psychological problem is more deep-seated. Many GPs do not approve of choice in principle. Most fear it in practice. Research by the department found a majority felt that choice would not improve their job satisfaction or make their life easier. The NAO found that 90 per cent believed their workload would increase and 91 per cent thought consultations would be longer. Overall, 61 per cent were either “very negative” or “a little negative” about patient choice. Is it surprising they have been so reluctant to log on?

The department should have communicated more coherently with GPs earlier: 92 per cent said they had no opportunity to influence the consultation process; 97 per cent said they had not been told about the timetable for the introduction of “choose and book”. Meanwhile, the British Medical Association has been advising doctors to boycott “choose and book” until its worries about patient confidentiality on the new NHS database have been assuaged. The Government has a massive task. Getting the technology to work is just the first step. Much harder will be to enhance the security of the system and win doctors over to its merits. Time is very short — and the cost has already been significant.