Bedford Hospital using C+B to manage demand, GPs claim

Bedford Hospital is rejecting GP referrals not made through Choose and Book in an attempt to manage demand for its services, according to local GP representatives.

The trust’s decision mirrors that of Milton Keynes PCT which recently told GPs that all referrals to Milton Keynes General Hospital must be made through Choose and Book, as EHI Primary Care revealed last week.

Dr Peter Graves, chief executive of Bedfordshire and Hertfordshire Local Medical Committee, said GP referrals to Bedford Hospital NHS Trust had been returned to be sent back through Choose and Book.

He told EHI Primary Care: “Bedford Hospital is using Choose and Book to manage demand and GPs are finding enormous difficulty using it. They still have patients requiring referral but the one main choice that patients want – their local hospital – might not be available.”

Bedford Hospital is one of many hospitals facing severe financial difficulties and cutbacks and is the subject of a high profile campaign led by consultant dermatologist, Dr Barry Monk. Dr Monk has set up the Save Bedford Hospital political party and plans to stand as a parliamentary candidate in Bedford at the next general election.

Dr Graves said concerns about the return of referrals had led the LMC to seek legal advice about GPs’ position in such cases which made it clear that even if a hospital returns a referral, the responsibility for dealing with the referral remains with the GP until a referral has been accepted.

Dr Graves added: “It’s not a satisfactory situation. GPs must either try to find somewhere else to refer someone or hold on until a slot does become available locally. Before Christmas we had a GP who had someone with severe chronic pain and the nearest pain clinic was in Bath.”

A Choose and Book briefing sent out to practices in October last year confirmed the intention of Bedford Hospital to only accept referral via Choose and Book. It states that the hospital was due to switch to directly bookable services by the end of November and adds: “They have advised that, from this time, appointments will only be available through Choose and Book.”

Last week it emerged that Milton Keynes PCT had also instructed its GPs that all referrals that were able to be made via Choose and Book must be sent via the e-booking system.

Dr Paul Roblin, secretary of Berkshire, Buckinghamshire and Oxfordshire LMC, said the LMC had told the PCT that there was no legal obligation on GPs to Choose and Book.

He added: “Most patients want to go locally even if it means waiting longer but to breach the target is something that is practically a hanging offence.”

A report from the King’s Fund issued last week, An Anatomy of GP Referral Decision looks at GPs’ views on patient choice and Choose and Book, based on research carried out at the end of 2005, and highlights the problem of choices that were “excluded by the PCT but highly desired by patients.”

The report makes five recommendations on Choose and Book , one of which states: “PCT rules for developing a choice menu should allow clinical departments in local hospitals to be included even if they have long waiting lists.”

Other recommendations on Choose and Book included the need for guidance to emphasise the central role GPs play in advising on clinical care, ensuring that where referral management centres exist there is an explicit policy about the range of advice that can be given and that referral to a named consultant should be a default setting.