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Hospitals limit GP referrals in chase for waiting time target

By Steve Nowottny

Hospitals across the NHS are abusing the Choose and Book system to clamp down on GPs' choice of referrals, in a desperate attempt to hit the Government's flagship 18-week target.

A Pulse investigation has found that in the past six months 90% of hospital trusts have cut their Choose and Book polling ranges – the number of weeks GPs using the controversial system can book appointments in advance.

The number of appointments listed as unavailable has risen sharply as a result. Among SHAs, the proportion of slots listed as unavailable is believed to range from 6% to 20%, with individual trusts reporting problems with up to a third of appointments.

The Department of Health and Connecting for Health both told Pulse they were aware of the problem, and condemned the manipulation of Choose and Book as ‘unacceptable'.

Dr Stephen Miller, medical director of Choose and Book and a GP in Lambeth, south-east London, warned the practice was causing widespread problems – and would not help hospitals meet their targets.

‘Patients are still getting seen but they're being seen in a very roundabout way so it's more inconvenient for patients, and GPs are having to fax referrals that they've already attached electronically,' he said.

‘If you cut the polling times without increasing capacity, it doesn't really help anybody. The hospital is still having to deal with these patients.'

But many of the 28 hospital trusts surveyed by Pulse insisted reducing polling ranges was ‘essential' to hitting the Government's target of a maximum 18-week wait between GP referral and hospital treatment, which has been made the NHS's top priority under Gordon Brown.

Several trusts said their polling range had been halved in the past six months, and for some specialties appointments could not be booked more than three weeks in advance.

Slot unavailability varies wildly between trusts. Connecting for Health tracking data obtained by Pulse suggests that in just one SHA, four trusts have more than 10% of slots unavailable.

One of them – Peterborough and Stamford Hospitals NHS Foundation Trust – admitted it had slot issues with a third of its appointments.

GPs expressed widespread concern at the findings of the Pulse investigation, and warned frustration with the misuse of Choose and Book could lead many to abandon it when financial incentives end in April.

Dr Mark Bond, a GP in Southport, Lancashire, said: ‘You can try to access a service on one day and find there are lots of appointments available – and then overnight there is none. They do control access to a service to make sure they are coping with the 18-week target.'

Dr Andrew Mimnagh, chair of Sefton LMC, added: ‘You cannot provide universal choice and universal 18-week access. The reality is that choice is sacrificed to ensure patients are directed, under some duress, to the capacity available – by inference the hospitals people do not choose to go to.'

How 18-week rule hits choice How 18-week rule hits choice

• Heavy Government pressure for hospitals to cut waiting times to hit 18-week referral-to-treatment target
• Hospitals cut number of weeks GP can book appointments in advance, to shorten waiting times from referral
• Unless capacity expands, this increases pressure on limited appointments
• Number of available slots falls, so GPs have trouble booking through Choose and Book
• Patients are forced to go elsewhere – or try to rebook, which is time-consuming for all

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