You are here: Home > Employment and contracts > Independent contractors > General medical services contract
Chapter 7 - Improving choice and booking in England
7.1 This one year directed enhanced service supports the delivery of two key priorities:
- to provide patients with an offer of choice where it has been decided they need a first consultant out-patient appointment
- to deliver patients booked appointments in secondary care by delivering booking arrangements through the national Choose and Book system.
7.3 The award to practices comprises two components.
7.4 The first component of this DES is an award for offering choice to patients via an initial discussion between patient and their GP about the providers on offer. The overall value of this component is 48p per registered patient as per the practice's list size at 1 April 2006. For practices to receive an aspiration payment representing 50% of this value (24p), they will need to provide the Primary Care Trust (PCT) with a written statement that demonstrates their commitment to ensure the reefrring clinician delivers the offer of clinically apprpriate choice to relevant patients. PCTs should then make prompt payment to practices. The remainder of this award (24p per registered payment) will be triggered if at least 60% of patients who respond to the new national patient experience survey recall a conversation about choice with their GP. The total value of this remaining award will be determined by the practice's list size at 1 January 2007.
7.5 The DES specification provides details about the practical responsibility to support choice and the practical support and information that needs to be provided to help patients make decisions on choice, including the role of the GP in the process. In some instances, PCTs will provide support via patient care advisers where patients require additional information about non-clinical aspects of their choice decision.
7.6 Component two is a reward for utilising the Choose and Book system. The overall value of this component is 48p per registered patient:
- for practices to receive an aspiration payment worth 24p per registered patient (according to list size at 1 April 2006), practices will need to provide their PCT with a written statement that demonstrates a commitment to utilising the Choose and Book system. PCTs should then make prompt payment to practices. Practices will be able to retain this aspiration payment providing the number of referrals (Unique Booking Reference Numbers (UBRNs) converted) made through the Choose and Book system reaches or exceeds a threshold of 25% of all referrals to first consultant out-patient appointments in June 2006
- the remainder of this award (24p per registered payment according to list size at 1 January 2007) will be triggered on a sliding scale based on the percentage of first consultant outpatient referrals made using Choose and Book by the practice (UBRNs converted) in the period 1 September 2006 to 28 February 2007. The minimum achievement in order for practices to receive any payment is 50% and is worth 60% of the value of this component of the DES. The full value of this award will only be due if the practice achieves 90% or more. National systems will monitor and report practices' usage to PCTs so that PCTs can make prompt payments to practices.
7.8 If at the end of the DES period practices fail to achieve the minimum level in either component one, component two or both components, PCTs should initiate arrangements for managing repayment of aspirational funding or for a balancing mechanism which offsets this repayment against other income due to the practice.