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A mockery of patient choice

Ask politicians about the choice agenda, and it’s likely that they’ll wax lyrical about patient rights, competition and the benefits of a free market. Ask a GP, and they’ll probably tell you about Choose and Book.

For all the NHS’ ideological rhetoric, in practice the choice agenda generally boils down to a GP asking a patient where they would like to be referred, and then using Choose and Book to arrange for them to be seen at the hospital of their choice.

Or not, as the case may be. For, as Pulse reveals this week, more than seven years after it was launched Choose and Book is still plagued with operational gremlins, and patients are suffering as a result.

Hospitals are routinely cancelling appointments if GPs fail to attach referral letters within an arbitrary three-day time limit. They are failing to record when consultants have booked holiday, then cancelling appointments that clash. In some cases they even seem to be failing to inform practices that appointments have been cancelled – leaving GPs, as ever, to pick up the pieces with understandably angry patients.

Such behaviour is completely unacceptable in a modern health service. Unilaterally cancelling appointments makes a mockery of the notion that patients should be able to choose where and when they are seen.

But, while the issues we cover this week are the latest in a long line of Choose and Book complaints, two factors make this story particularly significant.

First, the latest revelations come on the back of a Department of Health consultation earlier this year, Liberating the NHS: No decision about me, without me, which outlined a series of proposals to boost patient choice.

Practices were told they would have to use Choose and Book, offer choice through ‘alternative, potentially labour-intensive, methods’ – perhaps even phoning around hospitals – or face as-yet-unspecified sanctions. GPs may soon no longer have any choice about offering choice.

And secondly, there are growing questions about the wider principle of offering patients choice at all. We also report this week fears among CCGs that choice is destabilising secondary care, with some hospitals struggling to cope with rising demand and others struggling with lack of it.

In one respect, this is a triumph for patient choice. As funding follows the patient, and the fortunes of hospitals wax and wane, politicians can celebrate the fact that, at last, the drive to create a demand-led market in healthcare appears to be making progress.

GPs, though, stuck with the reality of Choose and Book and battling ever-tighter funding constraints, may wonder if the choice agenda as a whole is not a little wasteful.

Pulse is changing

Pulse is planning to improve the way it supports GPs next year.

We’re improving what we offer online and, if you haven’t already signed up to our upgraded website, you should do so today – it’s free, quick and enables you to get daily or weekly emails rounding up the best of Pulse’s content.

From January, we’ll also be relaunching Pulse magazine in a new monthly format, with all your favourite features but also more space for in-depth investigations, extended analysis and long-form interviews, which will allow us to delve deeper into the issues facing general practice.

We’re excited about the changes, and hope you are too. Find out more and let us know your ideas at