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Exposed: referrals system in disarray

Urgent cases face delays as Choose and Book and referral restrictions distort patient care

exclusive By Pulse reporters

An investigation by Pulse has uncovered serious distortions in patient care as a result of the Choose and Book system and NHS referrals policies.

Acutely ill patients are facing potentially dangerous delays in receiving care, research involving 64 hospital consultants across the UK reveals.

Patients are also being bounced between GPs and hospitals, forced to make unnecessary trips to distant clinics and to wait longer when they do get an appointment.

The problems stem from technical troubles with Choose and Book and a clash between the Government's patient choice agenda and the clampdown on referrals by PCTs and NHS trusts (see box right).

Of the consultants asked about the impact of Choose and Book, 40 cited problems.

Most raised an inability to prioritise between urgent and routine referrals via Choose and Book as a major concern.

This meant urgent cases were not being seen quickly enough. If these patients were identified and brought in earlier, they then faced long queues behind routine cases.

Professor Andrew Bamji, consultant rheumatologist at Queen Mary's Hospital in Sidcup, Kent, said: 'We have no idea what is coming in or whether routine referrals should be reclassified.'

Mr Andrew Jennings, orthopaedics consultant at the University Hospital of North Durham, said a 'two-tier

system' had been created as spaces had to be left for Choose and Book referrals, meaning conventional referrals had to wait longer.

Many consultants said referral letters sent via Choose and Book were either not arriving at all, arriving only one day before the appointment or were impossible to open. GPs are then forced to restart the referral from scratch.

Interference from referral management centres was also causing delays, consultants said, as well as more hassle for patients and an increase in workload for GPs.

Hospital doctors' criticisms follow repeated complaints by GPs, who have reported being stopped from referring to a

patient's preferred hospital or a named consultant and finding more referrals being returned.

Dr Lucy Marchand, a GP in Bletchley, Milton Keynes, said GPs at her practice were being prevented from referring if hospitals could not offer a slot within 13 weeks.

She said: 'These referrals automatically get removed from the [Choose and Book] system, which takes away patient choice.'

Dr Marchand added: 'I have only had one person in six months wanting to go outside Milton Keynes.'

Dr Richard Vautrey, GPC

negotiator, said the conflicts between Choose and Book, patient choice and PCT demand management needed to be 'untangled'.

'When and how long it takes is anybody's guess,' he said.

A spokesperson for Connecting for Health said the Choose and Book software did 'not in

itself create the problems that Pulse's survey has raised'.

He added: 'As utilisation increases there are inevitably new challenges to implementation, especially in trusts where capacity is stretched.'

pulse@cmpmedica.com

• Comment, page 74

How patient care is being damaged

• Urgent cases not being seen quickly enough because consultants unable to prioritise

• Patients forced to travel long distances to ensure hospitals meet waiting time targets

• Referral process has to start from scratch if patient needs to be seen elsewhere

• Referrals being refused because attachments either not arriving or can't be opened

• More appointments needed because of referral letters arriving late

• Longer delays for patients waiting at the hospital

The damning criticisms of Choose and Book

'This scheme is complex, expensive and unworkable'

Mr Jeremy Fairbank, consultant orthopaedic surgeon, Nuffield Orthopaedic Centre NHS Trust

'It is a disaster. We are having every possible problem'

Professor Jonathan Edwards, professor in connective tissue medicine, University College London

'The preferential treatment given to Choose and Book patients means trivial problems are seen ahead of more serious conditions.

Personally I call it "Booze and Choke"'

Dr Paul Reilly, consultant rheumatologist, Frimley Park Hospital, Surrey

'I have given up trying to manage the process of screening referrals as the software is such a pain in the arse to use'

Dr Mark Pugh, clinical tutor,

Isle of Wight Healthcare

NHS Trust

'Lots of problems; long delays that are difficult to explain, poor quality scanning/copying, a loss of control over who comes when, and a feeling of disconnection'

Dr Phil Barber, consultant respiratory physician, North West Lung Centre, Manchester

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