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At the heart of general practice since 1960

The health service's painful condition

With every passing week, the chaos surrounding GP referrals is getting more acute. And at every step of the process, the pain for both doctors and patients is getting worse.

At the heart of the problem is a fundamental conflict between the Government's patient choice agenda and PCTs' increasing need to cut hospital referrals to save money. This clash is complicated further by technical gripes with the Choose and Book system. These three elements are the corners of an NHS Bermuda triangle. And patients are disappearing in the middle.

System breakdown

GPs are told they must use Choose and Book to ensure patient choice, as it is better, faster and more convenient for all. Only it isn't. It's clunky, ultimately slower and much more problematic.

It doesn't ensure choice because GPs often can't get the patient into the clinic they want to go to because the hospital hasn't put the slots on there. Or its waiting list is too long. Then the referral management centre jumps in and decides the referral is not appropriate. Or the patient has to go somewhere else. Or their slot has to be delayed.

At the other end, consultants getting Choose and Book referrals don't know which patients are urgent. And if they spot one, they can't bump them up. That's if they can use the system at all. It is a farce, and entirely of the Government's making. Its mix of dogmatic policy making and on-the-hoof crisis management means doctors and patients don't know whether they're coming or going.

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