Cash constraints may ‘grey out’ C+B options, warns LMC

Patient choice may be restricted or “greyed out” under Choose and Book as cash strapped hospitals struggle to meet financial and waiting list targets, a local medical committee has warned.

Avon LMC, operating in an area with one of the worst financial deficits in the country, claims patients may only be offered second or more remote choices because local hospitals will limit appointments on the Choose and Book system.

In its latest briefing paper for GPs on Choose and Book the LMC says: “Local capacity planning appears increasingly at odds with C&B philosophy. There have been several discussions locally where it has been acknowledged there will be insufficient capacity in some areas to allow patient preference. In such cases the choice will be refused or ‘greyed out’ under C&B.”

Steve Mercer, chief executive of Avon LMC, said the fear was that choice would be limited because hospitals would be unable to afford to build spare capacity in to their systems.

He told EHI Primary Care: “I’m not saying this is happening yet but the issue has popped up in three different trusts. If a hospital has met its capacity and the patient is then offered an appointment 25 miles away patient choice won’t be choice.”

John Penrose, MP for Weston-super-Mare, Somerset, said he feared Weston General Hospital could be a likely candidate for “greying out” because both the hospital and the PCT were under financial pressure.

He told EHI Primary Care that the PCT has been historically underfunded to the tune of £12-13m and Weston Hospital was also too small to cope with the health needs of the expanded population of the district and therefore faced severe financial difficulties. He added: “I’ve heard concerns about “greying out” and although I don’t think its happening yet in Weston it would be likely to be one of the first hospitals to face capacity constraints so I would think it’s only a matter of time before it does happen.”

Restrictions on choice have already been raised by Devon LMC where cardiology appointments at North Devon’s district hospital in Barnstaple were unavailable for booking and patients were sent instead to Sidmouth community hospital.

Dr Charlie Daniels, chairman of the LMC and a GP in Torquay, said: “Cardiology was removed from Choose and Book because they didn’t want their waiting time target to be breached. When people started complaining about it they put it back.”

Avon LMC says it is also concerned about where responsibility will lie for managing referrals if hospitals start to refuse to accept referrals because of waiting list targets.

Practices in Avon have had one of the lowest uptake rates for Choose and Book in the country although Mercer says more practices are now starting to get involved.

However the LMC’s latest advice to practices is that it urges “great caution” in adopting Choose and Book, although it says it is up to individual practices to decide for themselves.

The LMC claims the directed enhanced service (DES) for choice and booking does not compensate practices fully for the work involved and estimates that a practice engaged in full Choose and Book would be undertaking unreimbursed additional work, possibly to the cost of about £4,000 per GP per year.

Mercer says that the LMC has sought accurate information on the workload involve d in Choose and Book for more than a year but without success.

He added: “I think it’s a national disgrace that no-one has been able to set down the total workload per GP.”

Mercer said the LMC was keen to see PCTs in its area introduce the “medical secretary” method for Choose and Book which allows practices to send Choose and Book information through the post and has led to widespread take-up of the e-booking system in Somerset.

Links

PCT achieves 87% C+B referrals with flexible system