A SCHEME costing millions of pounds that will allow patients to choose and book hospital appointments electronically from GPs’ surgeries by the end of the year is at serious risk of failure, according to auditors.

More than a third of GPs will not be linked up to the system by December, despite government promises that the network would be up and running, a report by the National Audit Office (NAO) has concluded.

Most doctors interviewed by the NAO said that they still knew little about the project, distrusted the technology and remained sceptical about it being able to do what was required. A third of hospitals were also found to have no plans to implement the system.

The report, published today, warns the Government that the £196 million Choose and Book project is likely to derail badly unless a series of technological problems and doctors’ concerns are addressed as a matter of urgency.

The concept of e-booking is key to the NHS’s new £6 billion IT system and Labour’s plans to offer all patients more choice of where and when they have hospital consultations. The Government has pledged to offer every patient referred by GPs for non-emergency treatment the choice of four or five hospitals, via the e-booking network, by December.

However, the NAO study found that a tiny fraction only of electronic referrals had been taken so far. Out of 9.4 million non-emergency referrals made before the end of last year, 63 were booked through the new system, rather than the hoped-for 205,000.

GPs’ reluctance and non-compliance of IT systems in surgeries and hospitals, as well as an intermittent technical fault, were also blamed for hampering progress. At best, the system will now be operational only across between 60 and 70 per cent of the NHS by December, the report concluded.

Edward Leigh, chairman of the Public Accounts Committee, described the situation as abysmal and a serious blow to plans to reform the health service.

He said there was a very real danger that if the Government did not solve the problems and failed to make electronic booking available throughout the country, the entire “patient choice” agenda — a central plank of the Government’s public service reforms — would be undermined.

Stung by the criticism, John Reid, the Health Secretary, will offer GPs an olive branch today by announcing a new system of cash incentives for doctors who hit targets for numbers of patients booked online, The Times has learnt.

Mr Reid is expected to use a speech in London to set out a system of rewards for GPs who meet targets, such as making 50 per cent of their referrals online. While acknowledging some progress had been made, the NAO report exposes a gulf between the Department of Health’s target on patient choice and plans for implementation. Nearly a third of primary care trusts were found to have no plans to introduce any patient choice while more than a quarter predict they will not achieve the December target.

A survey of 1,500 GPs also revealed that half of them knew very little about patient choice and 6 per cent were well versed on it. While most thought it will have a positive impact on patients’ experience, 90 per cent feared it will make consultations longer. Two thirds of the doctors were either very or a little negative about patient choice, while nearly half said it would make health inequalities worse. The report recommended that ministers urgently address the low level of GP support and consider speeding up the e-booking system. Sir John Bourn, head of the NAO, said: “Enabling patients who are referred by their GPs for hospital treatment to choose where they want to be treated promised to bring benefits to the patients themselves and to the wider NHS.

“Providing such choice will not be simple. The Department of Health must take urgent and effective action to inform and engage with GPs about the new arrangements. GPs’ support may be hard to secure and indeed choice will be hard to deliver successfully by the end of 2005 if the electronic booking system is not largely up and running by then.”

Doctors’ leaders said that the Government had failed to instruct them about the system, and most felt they were working in an “information desert”. Hamish Meldrum, chairman of the BMA’s GPs committee, said: “There is still a lot of work to be done before GPs are convinced that this initiative will be successful.”

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