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Independents' Day

Divided views on Choose & Book

I have now completely stopped using Choose and Book. It is pointless and offers my patients no advantage.

On the contrary, I find that by using it I have less time to spend dealing with my patients' problems. If the Government can find me one GP who is able to welcome a patient to the surgery, put them at ease, take an adequate history and examine the patient, explain management and maybe arrange investigations, talk about work implications and then add in Choose and Book – all in 10 minutes – I will do it.

My advice to all my patients on electronic records is: 'Do not tell me anything confidential you do not want dispersed around the internet. It is not a secure system, and is unnecessary and very expensive for an NHS that is short of money.'The only choice with Choose and Book is which building (hospital) the patient is seen in. There is no choice of doctor. Indeed, there is less choice than with the old system, where a patient was referred to a preferred specialist. What a load of rubbish.
From Dr Milton Barron, Manchester

We have used Choose and Book for two years and it is superior in every way to postal referrals.Secondary care is notoriously inaccessible from an administrative point of view, with a four-week 'lag time' built into the system as the letter is dictated, typed and sent (one week) and then goes through a labyrinthine process at the hospital, which is different for every department and consultant (three more weeks).

If the patient has limited English, the letter they then receive five weeks after seeing me telling them to call a number is not understood or acted on, and they return to go through the whole process again.Handing the letter to their relative/interpreter, which allows them to go and book the appointment, or one of our staff booking it for them, has saved us so many admin hours chasing failed referrals that our staff are quite happy to take on the Choose and Book workload.

Furthermore, when I am booking an appointment online I know that a patient I am worried about will be seen within, say, five weeks which is clinically reassuring. The 'Choice' part of it, much-trumpeted by a very foolish Department of Health, is often the least thing which the patient values – it is not waiting to book your holiday until the hospital deigns to contact them with an appointment.

The vitriol and hyperbole surrounding this issue is absurd. This is an IT solution to a communication problem with hospitals which no amount of previous initiative could solve. I understand the concerns of those who see this as a ploy to promote the internal market, and the notion that 'inefficient hospitals will not be chosen and will go to the wall' is definitely present in the Department of Health and the Choose and Book initiative.

There is no sign of this at present, however, not least because the demand within the system is such that every single appointment any hospital cares to create will be filled in no time. Since the cost-pressures in secondary care have resulted in reduced capacity, I cannot see this changing soon.

As for Dr Jeremy Halliday's Choose and Book syndrome (Letters, 24 May), looking the patient in the eye and telling them they will receive an appointment through the post may get them out of the surgery quicker but it won't get their piles injected any time soon – at least not without two more appointments and a phone call.
From Dr Ruth Brown, north London

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