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It's hospitals, not Choose and Book, that prevent named consultant referrals

Choose and Book may stop me saying sorry

From Dr Stephen Earwicker, Nottingham

Dr Christopher Lisk believes Choose and Book is 'breaking down the liaison between consultants and GPs' (Letters, 11 January). I support his view that for some of our patients, referral to a named consultant is important, but I'm not sure he identifies the right problem.

Pooled referrals were being introduced into the NHS long before Choose and Book arrived. In Nottingham, where I work, for most of our patients a pooled referrals system is to their advantage because the pooled systems are easier to manage for our hospital colleagues and have been the way to achieve shorter waits.

Once the hospital has a suitable computer system, Choose and Book does support and enable referrals to particular consultants, but it is hospitals that must choose to make this functionality available to us. It seems to me that Choose and Book is already adding real value by helping us to get rid of the legacy of NHS waiting lists that I have spent the past 20 years apologising for!

On the subject of communication with hospital colleagues, we have found that implementing Choose and Book has made us think much more about appropriate referral pathways and has been the trigger to have these discussions with our secondary care colleagues – sometimes for the first time!

There are clearly still challenges to overcome for Choose and Book, but when we have fully booked systems in

all of the NHS and modern electronic referrals, I predict a time when I will no longer need to apologise to my patients for the uncertainty of old-fashioned NHS waiting lists.

• From Dr Mark Davies.

Choose and Book

primary care medical director,

NHS Connecting for Health

In response to Dr Kate Mash's view that Choose and Book erodes GPs' autonomy (Letters, 18 January), I would like to clear up the important point she raises in relation to referrals to named consultants.

From the very beginning of Choose and Book (version 1) there was the ability to search for services by an individual consultant and indeed to refer to that consultant's clinic.

This is obviously something that is appreciated by a proportion of our patients and something that was considered important by those clinicians involved in the original system design.

However, in order to do this, hospitals have to allocate those consultants in the directory of services. The problem is that ever since there have been waiting time targets in the NHS, hospitals have found it easier to manage those waits using pooled referrals and have been reluctant to allow GPs to refer to who they want. I remember debating the pros and cons of this approach as a GP registrar 15 years ago – long before Choose and Book!

Almost three-quarters of English hospitals could accept named consultant referrals tomorrow, using either a version 2 PAS (Patient Administration System) or using an indirectly bookable system. So if you want to refer to named consultants, the conversation needs to happen between whoever commissions those services and the local trust.

The reason these trusts are not making this available now is not because of Choose and Book, although it might be something convenient to hide behind!

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