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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.’