The Department of Health has issued new guidance on using choose and book in response to concerns the system is “often unpopular with professionals”.

It says in some areas it has been used “not always in line with the way it was designed”. The guidance clarifies how the system should be used and says primary care trusts should, where possible, encourage GPs rather than “mandating its use”.

Referrals should always be initiated and accepted by clinicians, not other staff, it says.

Choose and book medical director Stephen Miller said: “In preparing this document, we have worked closely with clinicians, strategic health authorities and with the British Medical Association, who have all recognised that some of the local ways of working to support choose and book simply don’t work for patients and are often unpopular with professionals.”

Responsibilities and Operational Requirements for the Correct Use of Choose and Book follows a review published by the BMA in January this year, which found a mixed reaction to the system on a local level. Choose and book is used for 56 per cent of all referrals to first outpatient services across the NHS.

It states: “With over 13 million choose and book referrals to date, for many the system has become an integral part of the referral process. The BMA receives mixed feedback about choose and book with some clinicians praising the system for improving processes and others finding it completely unworkable.”

The foreword to the new guidance states: “Widespread variation currently exists in the local implementation of choose and book, which in some cases creates very poor experiences for patients.”

Health minister Mike O’Brien said: “When properly implemented, choose and book can provide significant benefits not only for patients, but also for referrers, providers and the wider NHS by delivering choice, certainty, security and reliability.”

BMA GP committee negotiator responsible for IT Chaand Nagpaul said: “We welcome the fact that the experiences of clinicians have been taken on board. It is crucial that trusts and PCTs meet the requirements set out in this document so that clinicians are appropriately supported when using choose and book.”