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How to ensure a successful choice and booking DES

In the final part of our Choose and Book series, Dr Mark Davies explains how to hit the enhanced service targets for choice.

The one-year choice and booking directed enhanced service (DES) supports the delivery of two key NHS priorities: ensuring patients are offered a choice of where and when they are seen if referred and using the Choose and Book service to make appointments for specialist care.

Detailed information on the DES's structure and what it is worth in income terms is available on the BMA and NHS Employers websites. But there are ways for practices to improve their chances of hitting all the targets.

The choice aspiration payment is straightforward. To qualify, practices must give their PCT a written assurance stating that when, during the consultation, the GP and patient first decide that a referral is necessary, a choice of providers will be offered.

GPs are not required to discuss a set number of choices with the patient, but the choices presented should be clinically appropriate.

The patient might not want to consider alternatives to the local hospital. This is fine - and represents a choice in itself.

Offering choice

There are exceptions where the GP does not have to offer choice, for example, when patients need rapid access to services, such as cancer or chest pain clinics, or are being referred to mental health or maternity services.

PCTs have been advised to pay the aspiration payment for offering choice promptly after receiving the practice's assurance that it will do so.

The second part of the choice component of the DES is more complex, but there are things you can do to help improve your chances.

To measure this element, a national patient survey questionnaire including a section on patient choice will be sent to patients. Which patients will receive a questionnaire and who will send it out depends on the outcome of GPC/NHS Employers discussions.

Out of the patients registered at your practice who respond, if a minimum of 60 per cent of those who were referred to specialist care remember being offered a choice at the point of referral, the practice qualifies for payment.

This part of the DES has created some concern for GPs, not least because some patients simply will not remember whether they were offered a choice. But a national survey was judged to be the best way of evaluating whether the patient's experience has really changed for the better. So it is all the more important to ensure that during the initial consultation your patients understand that they are being offered a choice.

You can raise patients' awareness of choice at your surgery with posters, patient leaflets and the 'Choosing your Hospital' booklet. This is available from your PCT or can be ordered from the NHS website. All this should help your patients to recall that they were offered a choice. And it will empower them to ask about choice of provider.

Booking targets

The booking component is related to using Choose and Book. The key is to understand what you, as the GP, need to do and how the practice team can support you.

For example, clearly the GP needs to identify the clinically appropriate specialty and clinic type in Choose and Book to which the patient should be referred. Usually, this means generating an appointment request for the patient to take away and book their appointment later.

However, with the appropriate training and clear guidance from the referring clinician, another member of the practice team could generate the appointment request.

The patient's password is automatically generated when the request is made. This just needs to be printed and handed to the patient.

I know plenty of GPs who are generating appointment requests and even making the booking during consultations. But I also know GPs who find that delegating the entire booking to their practice staff suits their needs better.

The Choose and Book service is flexible and designed to enable you to mould it to suit the way you work.

The DES states that where circumstances outside the control of the practice means it is unable to implement a particular programme, for example, because of 'regional or national difficulties', payments to practices will still be made subject to the PCT determining what is and is not a major event outside of the practice's control.

Varied response

In one area I know, Choose and Book uptake has generally been slow because the LMC has advised against it. But I know of a GP practice in the same area that processes all its referrals through Choose and Book.

Bear in mind that, if your practice experiences local problems with the system, you should not assume that the DES is not achievable and the PCT will wave its exemption wand and pay up. Find out from the PCT what type of regional and national difficulties will trigger this response.

The PCT should be your first port of call for help in any case. PCTs are performance managed on the take-up of Choose and Book in their area, so it is in their interests to help you.

You cannot expect to go from zero to 90 per cent utilisation overnight. If hoping to achieve the maximum payment of the booking component for September to February, it is strongly advisable for practices not yet using Choose and Book to be connected to the system as soon as possible. It is also advisable to start publicising choice to patients on the practice list.

- Dr Davies is a GP in West Yorkshire and national medical director (primary care) at NHS Connecting for Health.


- BMA and primary care contracting for choice and booking DES details - www.bma.org.uk and www.primarycarecontracting.nhs.uk

- NHS Employers website - www.nhsemployers.org

- Contact your PCT for local information on DES payments.

- 'Choosing your Hospital' - available from PCTs and www.nhs.uk

- Choose and Book website - www.chooseandbook.nhs.uk

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