Patients cannot remember C+B referral options

A total of 80% of patients in Selby and York Primary Care Trust claimed they were not offered a choice of hospital on referral when the Department of Health questioned them for Choose and Book.

The results of the survey on 649 patients will reinforce concerns from GPs that patients will fail to recall being offered a choice when the national survey for the choice and booking directed enhanced service (DES) is launched later this year.

Part of GPs payments under the DES is dependent on patients’ ability to remember that a conversation about choice happened before referral.

The Department of Health (DH) began the first wave of its national patient choice survey in July, in preparation for the DES survey which will determine the level of award payable under the booking component of the DES.

They randomly contacted patients from each PCT area in the country who have implemented C & B and asked them if they were offered a choice of hospitals to go to for their treatment that month. The full survey results are not yet available, but indicated that 1 in 5 referrals are now done via C+B.

Selby and York PCT was one trust which ranked nearly bottom in the country for the number of referrals made through the system.

One GP in the trust, Dr David Fair of the Jorvik Medical Practice, York, told EHI Primary Care that the survey was unfair because it was taken weeks after most patients had used the system.

“The questionnaire was to the patients to ask if they could remember being offered a choice, but this is flawed because many of my patients who need hospital referrals are elderly or have learning difficulties and cannot reasonably expect to be able to remember being offered different hospitals,” he said.

Dr Fair believes the payment system should not work in this way unless patients are contacted on the same day as their appointment with the GP who referred them was.

“We are offering our patients choice, but most just choose York. We can’t prove we are offering four sites and gain our payments, because they don’t want to choose, they just want to go to York. By the time, they fill in the questionnaire, they have forgotten that they had a choice offered to them,” he added.

Selby and York PCT told EHI that the Choose and Book system was slowly being implemented across the region and they expected to reach the 90% target set by the Department of Health for March next year.

“It is early days for the Choose and Book system here in Selby and York and meeting the targets set is something we have to work on as more of our GPs move to the system. Patients will see the benefits of avoiding waiting lists to be seen by hospital staff and will enjoy having the power to choose where they go for treatment,” a spokesperson said.

Dr Fair however believes that the targets set are “ridiculous” and CfH should review the way they judge whether or not a trust receives payment, rather than it being dependent on patients being offered a choice of where they go and repeating these options in the questionnaire.

“Every single doctor I know thinks Choose and Book is a complete waste of money and time,” he said.

In a letter to GPs in August, the national clinical director for primary care, David Colin-Thomé said: “The survey shows that increasing the publics’ awareness of their entitlement to choose their provider (when referred for their first hospital outpatient appointment) is very likely to have a large impact on their ability to remember being offered a choice.”

He added that the “Choosing your Hospital” posters and flyers would also be a useful reminder to patients that they can choose where to go for treatment.

Dr Richard Vautrey, a GP in Leeds and GPC negotiator, who has been helping the DH with putting together the new survey of patient experience, told EHI Primary Care: “Helping patients recall choices is one of the things we continue to emphasise. Any survey on choice needs to be done at a stage where the patient could reasonably be expected to remember.”

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1 in 5 referrals now done via C+B