Hospitals told not to use C+B to manage demand

Hospitals that have been using Choose and Book to manage demand by withholding appointments slots have been ordered to stop doing so by their strategic health authority for the second time in less than two months.

South East Coast SHA has told its hospitals and primary care trusts that it does not want routine patients to be seen “too promptly” but has forbidden trusts from using Choose and Book to manipulate the system by withholding appointment slots for which they risk not getting paid if a patient has waited less than eight weeks.

The routine withholding of Choose and Book slots by hospitals, to meet waiting list targets and to save money, has been reported at hospitals across England and is identified as one of several reasons holding back wider use of the e-booking scheme which the DH planned to be used for 90% of referrals by March next year.

National figures for the week ending November 19 show that 31% of referrals were made via Choose and Book, a growth of only 4% since 1 October. If use of the system was to grow at the same rate between now and the end of March take up of the service will have reached just 43% by the end of March, less than half the hoped for 90% target.

A spokesperson for the DH told EHI Primary Care: “Choose and Book will deliver safe and secure methods of electronic referral suitable for a modern NHS. In addition, it will deliver a fully booked NHS helping us to lose the legacy of waiting lists. This has never been attempted anywhere in the world and is ground breaking. Despite the challenging start where we have faced more complexity than we envisaged, progress is being made.”

Marianne Griffiths, deputy chief executive of South East Coast SHA, sent the first of two letters to all hospital and primary care trust chief executives on 1 October to highlight problems with Choose and Book. Her letter says that at the beginning of the financial year trusts and PCTs were asked to work together to balance the task of enforcing minimum waiting times of eight weeks for routine outpatient appointments while using the Choose and Book system which does not support the concept of minimum waits.

Her letter says: “It has now become clear that there are some Trusts who are unwilling to publish slots on the Choose and Book system for fear of non-payment should those slots be filled with patients whose wait is less than 8 weeks.”

The letter makes it clear the problem has also led to GPs making manual referrals, some of which have not been processed through Choose and Book, and orders trusts to ensure all services and slots are published on Choose and Book by all hospitals as soon as possible.

The October letter stated: “This is necessary not only to increase use of the C&B system, but to ensure patients of equal clinical priority are treated in turn.”

However the practice has persisted and Griffiths was prompted to write to trusts and PCTs again on 20 November restating her guidance on publication of Choose and Book slots.

This second November letter states: “From the feedback I have received, it would appear that this guidance is not being comprehensively adhered to. In particular, it would appear that not all slots are being published on the Choose and Book system, and that there remain a high number of services which are accepting manual referrals whilst sufficient slots are not available on the Choose and Book system. In order for us to successfully transfer to the Choose and Book system, this practice needs to end as soon as possible.”

Figures from November board papers for the SHA show 20% of referrals were made through Choose and Book in October, compared to 28% nationally.

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