Strategic health authorities are planning measures - from a radio campaign to crisis support squads - in an effort to make up lost ground in implementing choose and book.

Primary care trusts were tasked with referring 90 per cent of patients through the choose and book system by the end of last week, but latest SHA figures suggest that PCTs are barely half way to the target. It is one of six key goals for SHAs.

Even the best-performing SHA, NHS North East, was still referring fewer than 50 per cent of patients through choose and book, according to the most recent figures available. And the worst performer, NHS East of England, saw just 22 per cent of patients referred through CAB.

SHAs cite technical problems as a key reasons for falling so far short of the target, with a number of acute trusts still unable to accept direct booking via CAB. This includes eight of London's 32 acute trusts, five of them foundation trusts. Some are waiting for the national IT programme to deliver a CAB-compliant patient administration system, said NHS London.

The number of booking slots offered by acute trusts has also caused difficulties.

At NHS South East Coast and NHS North West, acute trusts are being told it is their responsibility to set up suitable appointments with a patient when they are told that no slot is available at their preferred provider. NHS North West is working on an alert system for commissioners so services can be removed from the CAB menu if a provider does not have enough capacity.

NHS North East is embarking on a radio campaign to improve the use of CAB systems. Its PCTs are also being encouraged to put greater emphasis on communications.

Despite the problems, many NHS bodies want CAB to be the only way to refer a patient from a GP. Last month, the NHS North West board discussed a paper which reported that meetings between SHAs and the Department of Health had heard of such a demand from 'many organisations'. A spokesperson from the DoH said: 'Although our latest figures from week ending 19 March suggest that the 90 per cent target will not be met across England by the end of March, there are. several PCTs that have made over 70 per cent of their referrals through CAB.

'There remain challenges, such as the availability of sufficient out-patient slots and the integration of IT systems with CAB.'

A British Medical Association spokesman said: 'While some GP practices are finding CAB usable, many GPs complain they find it a cumbersome system which takes up more time than the former referral system For others it does not work at all.'

SHA choose and book performance
North East:.48% (Jan)

South West:.46% (Jan).

East Midlands: 42% (Jan)

South Central: 41% (Jan)

Yorks and Humber: 39% (Jan)

West Midlands: 36% (Jan)

North West: 36% (Jan)

South East Coast: 31% (Feb)

London: 31% (Feb)