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GPs buried under trusts' workload dump

GPs can only refer via Choose and Book, CCG rules

Exclusive GPs are being told that referrals to some providers will only be accepted if they are made through the Choose and Book system.

NHS Oxfordshire CCG has told practices that referrals to the musculoskeletal services at Nuffield Orthopaedic Centre and community physical and mental health services at Oxford Health NHS Foundation Trust will have to be made through Choose and Book.

The CCG is currently funding GPs to use Choose and Book, but the LMC has expressed fears that the funding will be non-recurrent.

The move has also angered some GPs who argue that the system is time consuming and diverts their attention from patient care towards administrative activity and is potentially contrary to the contract.

The uptake for the Choose and Book system has stalled at 50%, with problems around double booking of appointments and providers failing to make appointments available inhibiting more widespread use.

As a result, NHS England is set to phase out the system, to be replaced with a new ‘e-referrals’ system, which is based on airline booking systems.

It was initially due for roll-out last year, but this was pushed back to this spring, although there is no indication around when it is being rolled out.

Despite this, NHS Oxfordshire CCG and the Oxfordshire trusts have said they have had to make Choose and Book compulsory because of ‘significant problems’ with patients being able to get appointments, and that referrals are being submitted in a number of different formats.

The CCG has said it has agreed this with the LMC, but the Berkshire, Buckinghamshire and Oxfordshire LMC newsletter revealed that GPs are against the moves.

One GP pointed out: ‘There is not a contractual requirement to use Choose and Book. Some practices feel that it reduces the workload associated with the referral process whereas others report that it is time consuming and involves more work. Practices are not using Choose and Book for a reason. Remove that reason and greater use will follow.’

Another said: ‘Having to directly book appointments in the consultation is not possible without cutting corners in the consultation. We are doctors, not booking clerks.’

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMC said: ‘Oxford University Hospitals has been slow regarding giving direct bookings.

‘Any surgery using it should be funded for backroom staff to do this. NHS Oxfordshire CCG does fund us for this, but there may come a point when it’s removed.’

He added that there was uncertainty about the legality of the move. He said: ‘If GPs went to court on it they might win on the grounds that it goes against the contract, but they could lose for deliberately deciding not to adopt it.’

Dr David Chapman, clinic lead for Choose and Book at NHS Oxfordshire CCG, said: ‘We have had significant problems with patients being unable to get appointments in a timely way.’

This had affected GPs, who were ‘undertaking a lot of extra work in chasing up appointments and reassuring worried patients’. He added that providers have had referrals submitted in several different formats, ‘making it very difficult for them to manage them in a standard way’.

Dr Chapman said: ‘In Oxfordshire 80 out of 81 GP practices use Choose and Book. We have agreed with our LMC that from 1 April 2015 providers may choose to accept referrals via Choose and Book only, unless there are exceptional circumstances when a patient or carer is unable to operate it. We are hopeful that this initiative will improve safety and patient experience, and reduce the workload for GPs and our provider hospitals.’

A spokesperson for Oxford Health NHS Foundation Trust said: ‘Using Choose and Book patients can leave their GP surgery with a first appointment date, time and location. Or, if they prefer they can choose to arrange their appointment at a later date via the Choose and Book website. GPs benefit by being able to get a much clearer sense of how a referral is progressing. They can track the status of a referral and see what current waiting times a service is experiencing.’

Readers' comments (19)

  • Peter Swinyard

    Paul Cundy (for those who don't know him, a serious GP IT expert) is right as ever.
    So is Sanjeev Juneja - this is unfunded work and we are not obliged to do it. If a majority of your CCG's practices disagree with the central edict they should call a meeting and overturn it. Most of us too busy doing the day job though...

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  • Paul,

    If you are "flagged" "stop noted" on PDS does n't that break Choose and Book and EPS so it cannot be used?


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  • Train practice staff to operat C&B and avoid it interfering with the consultation. Our practice secretary is second to none in managing it doe us. Knows to ask if cannot work out which clinic patient most suitable for.

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  • Interesting that CCG say LMC agreed, LMC don't. This is a difficult problem for CCGs. How do they find out if the membership agree. At least the membership can sack the clinical directors if they don't get the GPs on board

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  • As needing a referral myself quite recently for a steroid injection, I had to make an appointment to see my GP, for him to refer me to himself through 'choose and book'. What a waste of time and money. Once the appointment was arranged. 'Choose and book' still kept sending me letters to say I hadn't contacted them, more waste!!

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  • Where I am we have been forced to use C and B for all referrals for the past 5 yrs or so.
    My practice refused initially and were the last in the area to do it.
    We thought it was completely stupid.

    The PCT as it was then had some boxes to tick and must have had some target themselves to ensure all practices took part.
    In the end, it was incentivised for a year then ongoing funding withdrawn.

    This happens with all new or extra work dumped on us.

    So now it has become some sort of nebulous quality marker which is dragged up periodically at local network meetings and is audited because we are forced to use a specific Read Code for all referrals.

    I print most of the referrals out during consultation but regularly the system fails so I get my secretary to do it.

    Unfunded, of course.

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  • Took Early Retirement

    I never used it in my career.

    Exercise your right to paint your referrals on vellum, or perhaps a tapestry?

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  • Having worked with some of the doctors mentioned in the article , I'd say this is a genuine attempt to improve things for patients and also to help manage th he referrals burden.

    My experience was that Oxfordshire was making C+B work much better than what I've seen down here in London.

    I share the concerns some have stated above, that this may move admin work from (funded) secondary care into (buffet style, all you can eat) primary care. There may be a short term funding uplift, but how long before that is "rolled into" the global sum, then quietly forgotten?

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  • Are most of the commenters aware of the GMC guidance on the agreement with NHS England for a goal of at least 80% of referrals made through the NHS e-Referrals service (formerly C&B) by the end of March 2016, as part of the major steps towards the end goal of 100% paperless referrals?

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