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Two sides of Choose and Book coin

Dr Milton Barron of Manchester is quite right when he writes in Pulse (Letters, 14 June) that 'the only choice with Choose and Book is which building the patient is seen in – there is no choice of doctor'.

What about re-referrals? As the consultant or department holds the previous notes, I do not use Choose and Book for re-referrals but this deflates my Choose and Book percentage. What about antenatals? My local hospital won't accept Choose and Book anyway for routine antenatals, apart from in exceptional circumstances, so I refer directly and once again deflate my percentage. How accurate are their percentages anyway? I have a choice of one diabetic eye clinic that specifies request for appointment is sent by post! What choice?

Dr William Lettington, Lewisham, London

I was disappointed to read your story 'Quarter of a million lose out under C&B' (News, 28 June).

Motions debated at both the national LMCs conference and the BMA annual conference asking whether Choose and Book should be shelved were both soundly defeated.

The figures used in your article are back-of-an-envelope calculations, and combining the number of 'did not attends' (DNAs) and 'did not books' (DNBs) is misleading. You have based your claims and assumptions on data gathered from only 16 trusts, which are not necessarily representative of the 171 trusts across England.

Anyone adept at critical reading would ask – were the utilisation rates of these trusts representative of the national average? Who answered your telephone survey, and on what basis? Were the trusts asked about the DNA rates for their Choose and Book referrals or their total DNA rate? Use of Choose and Book varies greatly across the country and this is also true of the level of patients not converting their bookings. Although the rough average of DNBs across the country is about 10%, this figure hides a number of different stories. For example, we know many of these appointments have been booked on the hospital systems but not entered again on Choose and Book.

There are a variety of reasons for DNBs, such as patients who decided they did not want a referral or have changed their minds. In the old world of paper referrals, this would have been a DNA and would have been a waste of resources. There will also be cases where patients wanted to book an appointment but were unable to do so because of language barriers, simple misunderstanding or access problems.

We are working to map these factors and minimise them.The fact is 4.1 million bookings have been made through the system, enabling patients to choose an appointment at the date, time and place convenient to them. A small minority have not progressed their referral just as some of our patients do not collect their prescriptions.

There are issues to address in the new world of Choose and Book but this article doesn't do justice to the debate.
From Dr Mark Davies, Choose and Book medical director, National Programme for IT

Editor's note: We stand by our article. Dr Davies himself admitted the number of patients missing out on appointments under Choose and Book might be 'slightly increased'. Since Connecting for Health does not collect such figures, we felt there was a need to fill the gap. We asked trusts for the DNA rate under Choose and Book specifically and would be surprised if responders had higher-than-average DNAs – intuitively one would expect the opposite to be true.

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