The government is failing to engage GPs in its massive programme to expand patient choice in the NHS, a report from the National Audit Office has warned.

Ministers aim to ensure that by the end of this year all patients will be offered a choice of four or five hospitals for their operations.

The key to the system is a massive new computer project called "Choose and Book", which is currently being developed as part of the Department of Health's National Programme for IT.

However, an NOP poll of family doctors found that around half knew very little about choice and some 60 per cent felt negative about the plans "to some degree".

There have been fears that grassroots GPs have been excluded from the development of the system, and will fail to engage with it once it is rolled out.

"Choice cannot be delivered without support from GPs; they will be responsible for ensuring that patients whom they refer for elective care are given the required choice of providers," said the report.

"The engagement of GPs is currently low, however, and is a key risk which the Department must address to deliver choice successfully."

The watchdog also highlighted GP concerns about whether their practices had the capacity to deliver choice, the workload involved, and the amount of time for consultation.

There were also fears that existing health inequalities will be exacerbated.

With the DoH set to use 2005 to inform and engage GPs, the report said officials would "need to monitor carefully the progress of this campaign".

Choice delays

The NAO also reported that choice at the point of GP referral will not be universally available by the end of this year.

"On present plans only 60 to 70 per cent of the NHS will have Choose and Book available by December 2005," said the report.

"Until Choose and Book is fully adopted choice will have to be provided in other, less efficient, ways."

As an interim measure, senior officials are seeking to use interim IT systems until Choose and Book is fully available.

"Parts of the NHS still have much to do if they are to deliver choice," found the watchdog.

"A significant minority of primary care trusts do not yet have adequate plans in place to manage the introduction of choice and some may struggle to manage the required new commissioning arrangements.

"Just over a quarter of primary care trusts currently forecast that they will not achieve the choice targets.

"And two thirds have yet to commission the required number of providers. The department is developing a framework of support to help trusts overcome these obstacles."

NAO chief Sir John Bourn said that extending patient choice "promises to bring benefits to the patients themselves and to the wider NHS".

"Providing such choice will not be simple, however," he cautioned.

"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."

Benefits

Health minister John Hutton welcomed the report. "It confirms that providing greater choice over hospital treatment will deliver very real benefits to patients," he said.

"We are pleased that the NAO, the BMA and the Royal College of GPs continue to agree with us on this.

"The report also acknowledges that primary care trusts and GPs are moving in the right direction to deliver choice by the end of this year."

Health secretary John Reid also announced £95 million towards speeding up the implementation of electronic booking.

"Being able to choose and book hospital appointments at the family doctors is a crucial factor in delivering choice," he said.

"We have implemented the choice IT programme in stages. First we procured the equipment, second we made sure it worked, now we know the challenge is to roll out the service across the NHS.

"That is why since last autumn, as planned, my department has intensified its efforts to engage with GPs."