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Is it time to get rid of Choose and Book...

I was shocked to learn from Pulse (News, 10 May) that Choose and Book will cost taxpayers more than £200m to roll out across England and that 'the bill for the hapless system' exceeds £100m.

Confusion still prevails and only today a patient arrived at surgery in a state of agitation having been sent a letter from hospital asking her to make an appointment. When the patient phoned the hospital she discovered she was thought to be on the Choose and Book system but that they could not find the letter on the system.

This was hardly surprising as the patient had been directly referred by me by letter to a named consultant – being elderly, infirm and unable to cope with Choose and Book. Problems like this abound. A medical secretary phoned some while ago to say that the patient had arrived but there was no letter. But how could the letter go astray on the system, as the letter had been uploaded at the same time as when referred via Choose and Book?

Sometimes a hospital specialty I want to refer to cannot be accessed via Choose and Book – for example, assisted conception. Different hospitals have different names for some of their clinics. My practice manager has had problems locating breast clinics at some hospitals and now I have just given up and refer directly to the breast clinic at my local hospital. Service names for Breast Services include: Benign Breast, Breast Surgery, Clinic Breast Service, Breast Conditions over and under 35, General Breast and Breast Family History. But these services do not always match up with what services are provided by a specific hospital. As most patients have an initial mammogram or more complex imaging there is still a role for an initial access general breast clinic.

Similar problems can arise in areas such as chest disorders. I decided to do an audit of 100 hospital referrals and I am currently halfway through. Trying really hard, I have achieved a Choose and Book referral rate of 65% so far.

My main concern is that quite a number of patients just cannot cope with the Choose and Book procedures. Elderly people, those with severe psychiatric illness, people unable to use a telephone due to severe rheumatoid arthritis – just less than 15% of my audit fall in this category. One elderly infirm patient was able to be Choose and Booked only because her daughter came with her and took control of the referral. And by the way, has anyone succeeded in locating within Choose and Book a metabolic bone clinic?

I think this is the time for a U-turn – to drop Choose and Book and save a lot of money.

From Dr William Lettington, Lewisham in south London

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