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Choose and Book chaos as trusts cancel appointments

Exclusive: Overzealous hospital managers are routinely delaying or blocking Choose and Book referrals for administrative reasons, leaving GPs to deal with angry patients whose appointments have been cancelled, a Pulse investigation reveals.

Some practices are reporting up to 15 cancellations a day as hospital trusts increasingly insist that all referrals made through the controversial system are confirmed within three days.

And LMCs have also claimed that Choose and Book is listing ‘phantom’ slots when consultants are away or on holiday, and that GPs are not being told when appointments are cancelled.

Department of Health guidelines suggest Choose and Book appointments should be followed up with a GP referral letter within three days to ensure the appointment is ‘clinically appropriate’.

But Dr Philip Fielding, chair of Gloucestershire LMC, said ‘significant’ numbers of appointments were being cancelled without practices being informed, and ‘irate’ patients were chasing up their appointments.

He said: ‘A system designed to give greater choice and speedier referrals is being limited by bureaucracy and has disadvantaged patients.

‘The whole idea of Choose and Book is to plan ahead. For elderly patients, it has caused more delay and angst.’

He added that GPs were also booking patients into ‘phantom’ appointments that were later cancelled as the system could not tell when a consultant was due to be away.

Dr Andrew Mimnagh, chair of Sefton LMC, told Pulse local practices were experiencing ‘14 to 15’ cancellations a day, and booking of appointments when consultants were away was a particular problem.

Dr Manoj Pai, former chair of Coventry LMC, said practices in his area had also been hit: ‘We have referred and it has gone through and patients have been told to ring again because the appointment is not possible.’

Eric Gatling, director of service delivery at Gloucestershire Hospitals NHS Foundation Trust, said: ‘From September this year we have been taking a more robust approach to ensuring that patient appointments are confirmed by the GP within the three day period, in agreement with the PCT.’

Richard McCarthy, deputy director of performance at Southport and Ormskirk Hospital NHS Trust, said the trust ‘recognises there are shortcomings in the operation of the service on both sides’.

A spokesperson from University Hospitals Coventry and Warwickshire NHS Trust said: ‘The trust’s procedures ensure that all referrals to the trust are placed onto the patient administration system as soon as the trust receives them. The system is monitored by the patient access team to ensure all patients receive the care they need in a timely manner.’

The controversy comes at a crucial time for Choose and Book. GP usage has fallen to about 50% of referrals, but DH plans outlined in May revealed GPs may soon be forced to use Choose and Book or adopt ‘labour-intensive’ alternatives.

GPC negotiator Dr Chaand Nagpaul said: ‘It is unacceptable for patients to be penalised this way. There is no legal requirement for a letter to be received within three days.’

A DH spokesperson said national figures on cancellations were not collected: ‘We would expect local hospitals to take action so that appointments are not cancelled unnecessarily if there are any delays in receiving referral letters.’



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Readers' comments (24)

  • My experience of Choose and Book was woeful at times. Try to book a 14yr old to any mental health related appointment and you will be lucky to see any available slots appear anywhere . Services that should be available are witheld from the system and the patient usually end up with hobsons choice or none at all. Fax referalls now are hit with ever more stringent qualifying criteria.
    There is no excuse for not supplying a referal letter at the time of creating a CaB request other than laziness.
    In any case CaB will only ever work if everyone uses it. When choose and book brought up unsuitable options direct appointments were made instead. Thus depleting the options available via CaB even more. This is a viscious circle and will ultimately bring down CaB as everyine tries to short circuit the process.

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  • Bornjovial

    As a GP using C&B and as a GP with special interest in I.T , I see both sides of the coin.
    There are 3 main problems.
    1) C&B process itself
    2)Primary care related
    3) Secondary care related
    C&B is one the few well planned ideas in recent NHS IT but could be much slicker. It takes a long time than available in an appointment to be able to do C&B full justice. In a 10 minute appt one may decide on referral at 1 ,5 or 9 th minute. At that point it takes between 3-7 minutes to do a C&B. I tend to ask mobile numbers as well as some local hospitals do send out a text reminder. Also I tend to dictate the referral in front of the patient usually which takes up a few minutes. Some referrals are complex and hence are done later eg looking at old paper notes etc.
    2) Due to above and also medical and Human factors many referrals are not done in the time frame (?too tight for GP land). Eg secretary being off in a small practice or part time GP will have to come back to check the referral or waiting information from another clinic who advise referral to Y speciality to patient but don`t send a letter!!!
    3) Hospitals very often seem to allow booking into non existent clinics or when the consultant is on annual leave then they postpone the appointment several times( ???gaming the 18 week data) and this causes ill will with the patient.
    Remember patient sees the GP for worsening situation for no extra cost but hospitals get paid per appointment - even DNA`s.

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  • When referrals are sen tot hospitals, they take time in responding, extending the waiting time. It is quite common for the hospital to change the appointment at the last minute, one of my own appointments was delayed because they didn't have a junior doctor to sit on on the session, but nobody asked me for my consent and this has happened more than once!

    Choose and book gives you a date and time, but no guarantee that your appointment will be honoured, but can guarantee there will be a last minute change, which then takes your appointment out of the 18 week time span.

    Somebody did a greta course on how to buck the system!

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  • I have one simple question, does anyone feel GP's do anything right?

    I am stunned at the amount of GP bashing that goes on and wonder how GP's find the time to deal with patients when they have to deal with the constant barrage of criticism directed at them.

    If they made GP's fee values, I am sure there would be more cooperation across the board!

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