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Choose and Book is a threat to patients

Choose and book can be dangerous for breast lumps.

Dr Rob Bailey is absolutely right when he says (News, 19 July) ‘it was difficult for GPs to decide whether or not a breast lump was malignant'. This is, after all, the main thrust of sending a patient to a clinic.

Choose and Book has complicated the referral procedure, which can lead to 17% of patients not attending a clinic – a dangerously high proportion.

Looking at seven different large hospitals in my locality, the range of waiting times in urgent breast clinics is from four to 48 days, with a mean indicative waiting time of 26 days.

If a patient wants to go to a hospital breast clinic with a

26-day urgent wait, this may motivate a GP to use the 14-day rule for a suspicious breast lump, rather than face an average urgent wait time of 26 days for a patient with a breast lump to be seen.

The interface between Choose and Book and the 14-day rule has to be studied more closely. Keep the 14-day rule and drop Choose and Book. GPs should have rapid access to a breast imaging service before referral; this would help protect the 14-day rule.

Dr William Lettington, Lewisham, south-east London

Dr Bill Lettington: Keep the two week rule and drop Choose and Book Dr Bill Lettington: Keep the two week rule and drop Choose and Book

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