It was disappointing to see no mention of Choose and Book in your article about use of nurses in referral management centres, nor in the following comments from readers.
Choose and Book is an electronic referral management system and is designed to point GPs in the direction of the most appropriate services for a patient's condition.
If set up correctly, Choose and Book allows diagnostic, community and clinical assessment and specialist GP services to be shown alongside more traditional hospital-based services, providing real, cost-effective alternatives and eliminating the need for costly and restrictive referral management schemes.
Choose and Book acts as a highly effective decision support tool in selecting the most appropriate pathways for patients.
By using the clinical terms search and entering a symptom or diagnosis, GPs are presented with a range of options for their patients to choose from.
Behind each are links to a wealth of information including exclusion criteria, suggested prerequisite investigations and links to external guidelines and referral checklists.
When combined with the ability to ask for ‘advice and guidance', GPs will begin to appreciate the unrecognised power of this tool in supporting the appropriateness of referrals.
Like most GPs, I try to fully involve patients in decisions about their care. To be able to show them the range of options on the computer screen and help them understand why one option might be better than another is a more efficient use of my time and skills than having to spend time explaining to a confused patient why someone else has decided to overrule my referral decision.
But for Choose and Book to support the referral process, two things are required.
Firstly, instead of restricting access to hospital services, PCTs and commissioning groups need to focus on improving visibility of all services on Choose and Book, providing comparable alternatives to hospital-based services.
Secondly, all GPs need to use Choose and Book themselves in a clinical setting so they can search for the services most appropriate for their patients and follow the clinical guidance that is built into the system.
I know that many GPs were put off using Choose and Book when it was originally introduced six years ago. But since then it has evolved to be faster, easier to use and more relevant to clinical practice.
I hope more GPs may consider trying it again, especially if it can help them to retain the professional and clinical responsibility that is rightly theirs.