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Choose and Book goes west

Our blogger, Dr Peter Weaving discovers patients are travelling 100 miles for a bread and butter orthopaedic appointment.

Our blogger, Dr Peter Weaving discovers patients are travelling 100 miles for a bread and butter orthopaedic appointment.


The health economy here in Cumbria is as fragile as the one you work in. Trying to support the local hospital services with appropriate referrals is part of my role as a practice based commissioning lead. For these small DGHs to survive – we now have three with their concomitant inefficient duplications looking after a population that would normally support one – they need to maximise their market share of the referrals. Can you imagine the chagrin of discovering that ten per cent of our health spend is going off the patch? We give them hell about shortening lengths of stay and improving clinic appointment slots and then send the patient to St. Elsewhere's.

Now I think it entirely reasonable to go to a tertiary centre for your brain transplant but when we drilled the data we found an embarrassingly large number of routine referrals for bread and butter stuff – especially orthopaedics – going west, or in our case, east. For whatever reason patients were choosing to travel between fifty and a hundred miles rather than attend their local DGH. Why? Further embarrassing revelations – we really don't know why. And the reason we don't know is that my docs are not doing the Choose and Book bit themselves but asking patients to see a trained receptionist or secretary.

My homework now is to find out what is going on behind the closed doors of that "other" consultation…

Dr Peter Weaving is a GP in Cumbria and locality lead for Cumbria PCT

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