The infinite wisdom of NHS IT

What was wrong with the old system: -
It was slow, it could be unreliable, it wasn't secure

What is wrong with Choose and Book: -
in many hospital trusts, the functionality that allows referral to a named consultant isn't yet active or the hospital hasn't activated it, as using pooled clinics allows easier resource planning

What was wrong in the case referred to in the article: - is it naive to think that a case could be passed from one consultant to another, particularly as he/she KNEW that the other consultant was more appropriate?

CaB - not perfect, but better than the old system Robin

The puzzling thing is that the second consultant accepted the referral of a patient with CFS despite not having an interest in the condition. Jeremy Fletcher

As a recently qualified GP, I have already survived two great sea changes in information technology. The first was MTAS, the binary equivalent of the blitzkrieg. Set up in 2007 it is a centralised, highly bureaucratised system aimed to give young doctors the rotations they didn't want in the location they never wanted to be in. MTAS is a kind of enormous, complex, electronic roulette table. To be able to play the game you first have to buy chips (usually 6 years of medical education and 20k of student debt). The croupier (aka the royal colleges) spins the wheel and the poor old junior doctor bounces along until he gets rattled and squeezed into a convenient pocket. Black 34 = cardiology in Bristol, red 28 = general practice in the West Mids. And like a game of chance it's best to spread your applications thinly over many different specialties in the hope that you might get one you're vaguely interested in. The second is the e-portfolio. For the uninitiated this is a programme that stores exhaustive information about a GP registrar's 'learning' on a central super-computer, rumoured to live somewhere in Peru. The hapless GP trainee has to record his thoughts, his conversations, his activities, his reading, his exam results, his clinical skills and his ignorance, on this central database. There are reports that the programme can even physically remove the human soul. This is all dressed up as learning, but in actual fact it is a form of insidious brain washing, a Stasi-like indoctrination into the professional attitudes deemed suitable by the GMC and Royal College. Completing the e-portfolio leaves no time for actual learning, leaves no room for creativity and creates a bloodless clone of fearful GPs who know f**k all about medicine. I say to the college and I say to the super-computer in Peru, lick my f****ing balls! Kev

In answer to Robin - Nuneaton: I thought C&B was trying to put the patient at the heart of healthcare, overriding the doctor knows best approach? So explain again why things that are easier for hospitals, using pooled consultants, override patients' best interests, seeing the most appropriate consultant at their first appointment. Getting it right the first time. Even the in the old system, referral letters were read before the patients were seen. It seems to me that the only winners are hospitals, switching on bits, and switching them off again at their whim. Few have implemented the online booking element, while GPs in the majority have taken up this scheme with great reluctance, as they recognised the main loser would be the patient. Hospitals have used it to completely sideline the patient, reduce their choice, and manage patients to fit the hospitals agenda. Sorry C&B can do better. Disappointed

What probably happened is that the consultant didn't check the CAB referral before the patient arrived at the wrong clinic. Once a CAB referral has been sent the appointment is made and stays in place by default, unless the consultant 'adds an advocacy requirement' for a clerical person to change the appointment to another clinic or consultant. Sometimes CAB does not let us add the advocacy requirement and asks us to try again later! It seems to be rare for GPs to make CAB appointments personally, presumably because of the time taken, so this is delegated to clerical staff. Writing a letter to a named consultant is no guarantee that the patent will get to see that person if the appointment is made by CAB at the primary care end, because the appointment may be in another consultant's clinic. We cannot just 'pop up' in outpatients to see one patient if we are in the middle of an operating list, doing a peripheral clinic in another hospital, or in a management meeting. Michael Lumb

In answer to Michael Lumb: Thank you for making my point for me. Firstly, the point about hospitals being selective as to what they activate on their system. CAB does have a named consultant element, the majority of hospitals have elected not to activate it for the previously mentioned reasons. We have been told directly by choose and book advisors, and very expensive management consultants hired to talk for them and role it out that the patient has the right to choose which hospital, and when the appointment is. They do not have the right to choose a consultant. Now if the GP knows more, and would like to short cut things, and using LEAN management principles get things 'right the first time', save 'waste', and multiple appointments, trips to the hospital, delay for patients booking a second appointment, parking, petrol, and reduce the carbon footprint of the NHS, all he has to do according to CAB officials, is state the name of the doctor in the body of the referral. This only works if the consultants at the other end bother to read the referrals before clinic, and redirect patients to the most appropriate clinic. If hospitals would switch on named consultant there would not be a problem, but they will not. If someone bothered to read the referrals there would not be a problem. Who loses out, you guessed it, the patient again. So all this system is really serves one function, better clinic management for hospitals, and improves their ability to count appointments, and charge for them, thus monopolising NHS budgets. I am afraid I am still disappointed. Still Disappointed

Choose and book certainly doesn't win for the hospitals... we have no control at all over the number of referrals and yet get fined if the number of referrals exceeds the available appointments in the 11 week time limit... and you can't just appoint another consultant quickly if the referrals suddenly jump one month. The number of referrals from outside our area suddenly jumped when a neighbouring hospital failed to appoint consultants in our specialty after a colleague's retirement, and it has been incredibly difficult to cope. If you provide named consultant options on C&B you have to provide enough appointments for that individual to meet demand. Despite PBC, intermediate care and all the rest of it our referrals have still gone up by 20% this year and it makes it difficult to plan services. LJK