Large scale takeup of C+B DES predicted

The majority of GP practices in England are likely to sign up for the choice and booking directed enhanced service, according to Dr Mark Davies, Connecting for Health’s Choose and Book primary care medical director.

Dr Davies, a GP in west Yorkshire, says CfH is still waiting for returns from Primary Care Trusts to confirm take-up of the directed enhanced service introduced this month as part of the revised nGMS contract for 2006/7 but says he expects widespread take-up of the DES.

He told EHI Primary Care: “Anecdotally it’s exactly what we expected which is that the majority of practices see that this is some thing worth doing. There are such significant benefits for patients that most practices are going ahead with it.”

The DES, worth a total of £50million, is split into two components for delivering choice and using the Choose and Book system. Each component is worth 48p per patient. Half is paid for aspiration and the other half is paid based on achievement.

To achieve the aspiration payment for choice practices must provide their PCT with a written statement that demonstrates their commitment to offering clinically-appropriate choice. The rest of the choice payment will be triggered by the results of a patient questionnaire.

Practices can earn the aspiration payment for Choose and Book by providing a written statement that they intend to use Choose and Book. The payment can be retained if practices are booking 25% of bookings through Choose and Book by the end of June. The rest of the payment is available on a sliding scale depending on the percentage of bookings.

Guidance from the BMA on the choice and booking DES outlines how the scheme will work but makes no judgement about whether GPs should sign up. It says: “As with all DESs, whether a practice decides to participate is entirely their own decision.”

However the guidance does advise local medical committees to make sure all PCTs had offered the DES to practices by the beginning of this month.

LMCs themselves appear to be divided about advice on participation to members. Some, such as Avon, have advised practices to think very carefully before going ahead while others, such as Devon, have urged practices to take advantage of all the newly negotiated DES payments.

Dr Harry Yoxall, Somerset LMC secretary, said there was a lot of doubt among practices about whether it would be economical to deliver the booking element of the DES. He told EHI Primary Care: “The system is improving all the time but none of our practices are using the integrated version yet and it is hard to find the time in a busy surgery so I suspect the take-up will not be universal.”

Dr Yoxall said a further sticking point for some practices was the requirement to send out all referral letters within three days.

He added: “For some practices that’s not a big problem but for others it may mean significant changes in the way they operate, particularly smaller practices where secretaries may only work part time. Although three days is ideal most practices aim for a one week turnaround for letters.”

Dr Russell Walshaw, chief executive of Northern Lincolnshire and East Yorkshire LMCs, said take up of the DES was likely to be high although there was continued concern over the software.

He added: “There is also concern over how well patients will remember if they were given choice when they come to fill out the questionnaires.”