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Hospitals booking urgent Choose and Book referrals into ‘shadow’ slots in ‘non-existent clinics’



Exclusive: Hospital trusts are booking urgent GP referrals made through Choose and Book into non-existent ‘shadow’ slots before rearranging a real appointment, a Pulse investigation reveals.

The practice, which in some areas affects patients with suspected cancer, was described by the GPC as ‘highly dangerous’ and the Department of Health has already intervened in one trust to ensure its procedures are improved.

The latest concerns about Choose and Book come after Pulse revealed last month that appointments made through the contraversial electronic booking system were being routinely cancelled due to administrative reasons, leaving GPs to cope with angry patients.

University Hospitals Coventry and Warwickshire NHS Trust told Pulse it routinely booked urgent Choose and Book referrals, including two-week cancer referrals, into non-existent Sunday clinics, and then later rebooked the appointment.

A spokesperson said: ‘These types of appointments are booked as a shadow appointment so that the Patient Access Team can easily identify an urgent appointment booking and make contact with the patient to agree a suitable time.’

The trust said its patient administration system could not transfer the site of any suspected cancer from Choose and Book. The spokesperson added: ‘It is imperative the trust has this information in order to report and track two-week-wait patients.’

A number of other trusts also said they used ‘shadow’ appointments. A spokesperson from the Royal Surrey County Hospital said all appointments were booked ‘provisionally’ and patients informed, but they were not accepted until a consultant had reviewed the referral.

Central Manchester University Hospitals NHS Foundation Trust said that for some of its Choose and Book services, including urgent referrals, shadow booking was used to ‘ensure that patients are seen in the correct consultant clinic’.

A spokesperson said: ‘In such cases patients can book a time slot which will subsequently be confirmed or otherwise direct with the patient by the relevant hospital.’

Dr Manoj Pai, a GP in Coventry, said he was concerned because practices could not track urgent referrals.

He said: ‘We won’t know if they have been seen. If something goes wrong patients could slip through the net.’

Dr Paul Cundy, chair of the GPC’s IT subcommittee, said the arrangements were ‘highly dangerous’.

He said: ‘For an urgent referral you need confirmation and action at the other end. Choose and Book doesn’t provide that.

‘If the Government wants doctors in general to use this system for urgent referrals then they need to be offering an indemnity for doctors should the system fail.’

Dr Nigel Watson, chief executive of Wessex LMCs and a GP in the New Forest, said he had raised concerns with a local trust after the LMC discovered patients were being booked into ‘non-existent clinics’.

He said: ‘When we called the trust out on it, they refused to say it happened.’

A Department of Health spokesperson said it would raise the matter with University Hospitals Coventry and Warwickshire NHS Trust: ‘Choose and Book does allow patients who need to be seen urgently or within two weeks to be booked directly into appointments.

‘We have offered to work with the trust concerned and will continue to work with local organisations to help them improve their local Choose and Book processes.’

How ‘shadow’ appointments work

GP makes an urgent referral through Choose and Book

Trust books patient into a dummy appointment – for example, on Sunday

Trust re-books patient into a real appointment