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Phil wonders why patients get so much choice when all they really want is treatment

Unnatural selection

The apocalyptic day has finally arrived. I honestly thought that

the moment we would have to implement Choose And Book would never shuffle into view.

I thought if I ignored it long enough, Choose and Book would disappear up its own arse like so many previous half-cocked dumb ideas. In this case I was wrong.

Choose and Book is with us,

in all its glorious meaningless irrelevance. It is suddenly a part of the way I do my job. If I don't play the game, then apparently I will take some massive pay cut. I can't be fussed to investigate the details of this supposition, but suffice it to say that I'm not happy about it.

We are constantly told by our elders and betters in the Department of Health – and the polls are supposed to support this – that the public wants choice. They want to choose where and when they are treated, and by whom.

I have to say that I have never heard so much garbage in all my life. I can imagine that, if you are an educated middle-class individual living in London within a few miles of a number of major hospitals, and if you have a lot of spare time, access to the internet, postgraduate qualifications in statistical science and an overwhelming sense of paranoia, then you might give a monkey's which hospital you get referred to.

But I've never met anyone like that, let alone had them as patients. This is a classic example of metropolitan political intellectuals imposing their centralised values on the vast majority of normal parochial people who frankly don't give a toss. All my patients live in Sunderland, and when I trot out the Choose and Book mantra I am invariably met with a look of bemusement. 'You need that hernia sorting out,' I tell them. 'I can refer you to Hartlepool, Newcastle, South Shields, Durham, or you can go private to Washington. It's up to you.'

'Why can't I go to that great big hospital over there?' they reply. 'The one we can see out of your window. It's only 200 yards. I could walk home after my operation.'

'Fair enough,' I tell them. 'I'll refer you to Sunderland. Please tick the box on this form to tell Patsy Hewitt I've given you the choice.' Literally never, in 14 years as a GP in this city, have I had a patient who wanted to be treated anywhere else, with the minor exception of a few nurses who wanted their abortions in a department they didn't work in, and we were perfectly capable

of accommodating their wishes under the old arrangements.

There is a big pile of patient questionnaires sitting on my desk called The GP Patient Survey – Hospital Choice. I am supposed to dish one out every time I do a referral. I opened one today, out of curiosity, and it asks, in effect: 'Did your GP give you a choice: yes or no?' Then it asks the patient's sex and age. They appear to be otherwise completely anonymous.

I keep forgetting to give them out; I have other concerns that occupy my time. If I were amoral and cynical (but obviously I'm not) I would suggest that we don't bother our patients with such trivia, as they tend to have more pressing worries, and simply fill them out ourselves as we see fit.

I would never do that of course, and I'm sure none of my GP colleagues would either. Because that would make what appears to be a hugely expensive, if terminally flawed, national survey completely meaningless and a waste of taxpayers' money. And we would not want that, would we?

pulse@cmpmedica.com

Dr Phil Peverley is a GP in Sunderland and PPA and MJA Columnist of the Year

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