One of the centerpiece projects in the massive IT infrastructure upgrade of the NHS is not only running behind schedule but also risks losing the support of doctors and other health workers due to a lack of engagement with the medical profession, the public spending watchdog for the UK government warned in a report published Wednesday.

According to the report by the National Audit Office (NAO), an online appointment booking system called Choose and Book was scheduled to make 205,000 bookings by the end of December 2004, but only 63 live electronic bookings were made.

Rather than reaching its target of 100 percent availability by the end of 2005, the government agency said it now expects only 60 percent to 70 percent of the NHS will have access to the system by then.

Choose and Book, commissioned by the Department of Health's National Programme for IT (NPfIT), is designed to allow patients to make hospital appointments online from a choice of locations. Atos Origin SA was contracted in 2003 to deliver a functioning system and Cerner is providing the software.

The first e-booking was made in July 2004 but only 63 e-bookings were recorded by year's end, according to the NAO report. "Problems have included the reluctance of users to work with an unreliable end-to-end system, limited progress in linking to GP (general practitioner) and hospital systems and the limited number of GPs willing to use the system," the NAO said.

The British Medical Association (BMA), a professional association for doctors, said much work needs to be done by the Department of Health and, in particular, by the NPfIT before GPs are convinced that the IT initiative will be successful. GPs feel they are working in an information desert and need much more detail and experience of what is involved with Choose and Book, the BMA said.

Additionally, many GPs are still not completely satisfied that the system will protect patient confidentiality, and they will not have confidence in the new system until this is properly addressed, the BMA said.

Atos Origin denied any role in the delay of the Choose and Book system saying it had delivered a functioning Electronic Booking Service software application on time and on budget.

"The NPfIT recognises that the delay is in no way the fault of Atos Origin. NPfIT has extended Atos Origin's contract by three months," the company said in an email statement. "As stated in the (NAO) report, Atos Origin agreed to defer some payments to later in the same financial year (2004) to reflect the low usage of the system. Overall, this in no way impacted the financial position of Atos Origin." The company declined to comment beyond the statement.

Health Secretary John Reid said in an interview with the BBC today that the Choose and Book system was weeks, not months or years, behind its targets and that the progress of the project was not as "dramatically bad as it sounds."

Officials from the Department of Health also said that more than 2,500 GPs have already been involved in developing systems to support the government's aims and that the department will seek to increase engagement with GPs during the year.

According to the NAO's survey of 1,500 GPs, around half of these know very little about the IT system and 61 percent feel either very negative or a little negative about the Choose and Book system.

"GPs' concerns include practice capacity, workload, consultation length and fears that existing health inequalities will be exacerbated," the NAO report said. "The Department has deliberately held back its main effort to inform and engage GPs about choice until it has had a working e-booking system to show GPs, but it intends to mount a campaign to inform and engage GPs during 2005."

When asked today, health workers in a local doctor's office in Brixton, south London, had not even heard of the project and complained of being hampered by old and inadequate office computers as well as drawers full of paper files.

Later today, Reid announced a new government plan to spend £95m on incentives designed to speed up the implementation of its program for offering NHS patients more choice, primarily through the Choose and Book system.

The two-year program will offer hospital groups, called Primary Care Trusts, rewards over three stages for meeting targets. For example, as part of the first stage, incentives will be available to the trusts when family doctors install the Choose and Book system and offer choice menus to their patients. The final stage aims at getting GPs to use the system for 90 percent of patient referrals by the time "the system is fully implemented in 2006," Reid said.

The BMA quickly responded to the incentive plan, saying that though the extra investment is welcomed, the plan will not address the fundamental problems that GPs have with the new system.

The chairman of the House of Commons Committee of Public Accounts, Edward Leigh, who is also a Conservative Member of Parliament, called the progress towards delivering the IT system "abysmal" and accused the government of failing to provide value for taxpayers' money. With only 63 e-bookings having been carried out, "the average cost so far (of Choose and Book) has been £52,000 a booking. This is against a background of some 9m referrals each year," Leigh said.

Along with the Choose and Book system, the NPfIT is implementing new local IT infrastructures, a system for transmitting prescriptions electronically and a database of electronic health records for 50m patients in England, accessible by 30,000 doctors and handling five billion transactions a year by 2008. Last October, the Department of Health announced that its 10-year cost estimate (2003-2013) for the project had jumped from £6.2bn to between £15bn and £30bn.

Other companies with contracts for the NHS IT project include Oracle, which is providing the database infrastructure for the project, and Microsoft, which has been contracted to develop a user interface.

The NHS IT project is the biggest in Western Europe, with the UK government being Microsoft's third largest customer, Reid said Wednesday.

Scarlet Pruitt, in London, contributed to this report