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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)

  • Could we have some numbers to back this up. How many cancellations are due to failures to supply referral letters and how many for other reasons.

    As someone with some knowledge of both good and bad hospital booking processes here is my view of what is going on. Tthe main "problem" is that local hospitals have started applying the rules to prevent appointments being cancelled much later because the referral letter has not been submitted. Other reasons are probably very real but minor compared to the issue of delays in sending referral letter. They look as though they are being used as a smoke screen .

    This is just my prejudiced take on the story as it currently stands. That is why I have suggested some more numbers would be useful.

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  • Two things - firstly this is irresponsible tabloid journalism - labelling the hospital manager 'over zealous' is the journalist acting as judge and jury - not professional and certainly not balanced. Whatever happened to the pursuit of truth?

    Secondly, a careful analysis of the story reveals that this is an example of the GP not following the correct CaB referral process, and then blaming the hospital for rejecting it. This is then followed by the usual over-egging of the GPs complaint by throwing in all sorts of other appointment issues.

    I agree with the previous poster - stick to the facts, and provide the evidence.

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  • This article is mis-guided. As an ex-Choose and Book Project Manager, I know first hand that happens on both primary and secondary care and sadly how the patients are caught up in the cross fire. When C&B was first launched a lot of areas worked with both primary and secondary care to ensure robust governance and operational framework was put in place to ensure best practice and improved patient quality. As with most NHS Projects, the next 'big thing' would come along and most areas disbanded the C&B teams and the enthusiasm and best practice was lost. As a result most hospitals appointments and referral letters from both stakeholders (GP's and hospitals) are misguided and mis managed, resulting in stories like this. If CCG's want to improve the situation, invest in people with significant experience to work with GP's, patients and the hospitals to improve C&B and make it work for the purpose it was designed and further more, make a case for continued investment and improvement. It can and could do so much more than it currently does.

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  • Vinci Ho

    There are clearly two factions here : pro C&B and anti C&B . While it is not quite professional to report news with a judgemental angle , it is also very important not to 'ignore' these cancellations . They are indeed happening everyday . GP referral letters is only one issue . It cannot be THE issue.
    Perhaps C&B is just a mean of transparency to show how difficult it has been for at least some hospitals to cope with their workloads . This is not new but is going to get worse with austerity measures. God bless......

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  • I am still a conscientous objector to choose and book and refer my patients by letter in the traditional way. This has caused my practice no problems whatsoever and saved me and my staff a lot of unnecessary and unresourced work and my patients a lot of hassle and anxiety.

    Come and join the non users.

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  • I'm moving away from C&B as the time goes - the connections are slower (?more users), doesn't always give me the right choice, some choices are unreasonably difficult to understand (breast, other 2ww is not a cancer referral but 2ww, breast is cancer referral).

    Worst of all, I'm forbidden to give choice by my CCG (or PCT as they were) - I'm told I shouldn't use the local private hospital even though they have contract with NHS and appear on C&B, I shouldn't refer to other trust as it costs more, I can't pick consultants by name as it make waiting too long in some areas etc etc. So what's the point - other than making GP work as free admin for secondary care of course.......

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  • Neil Bhatia

    I'm so glad I gave up using C&B many years ago. Won't use it again.

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  • My experience is that choose and book has always been chaotic. The only choice is for patients who don't care where they go, ie they don't want choice . Any that are specific about their requirements find their choice blocked.

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  • All of the comments above are not new and not surprising given the lack of ownership and direction of what has the potential of being a good system. I have seen if in the majority of cases work well, likewise I have seen poor experiences. Lets not forget, it's not so much the software that supports C&B that is the issue but the organisations which own and drive it. It is a health economy wide system and not one individual or organisation is to blame. Perhaps if all those so anti actually got involved with the solution then maybe it could be in a better state to be continually improved to move with the times, the patients and the GP's expectations and actually deliver something worth while. Lets be clear - I am not for nor am I against Choose and Book. I do however, think people forget that Project Managers are merely there to implement any given project; not be politically aligned to any view point.

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  • Vinci Ho

    Interesting comments
    More are welcome

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