GP questions Hewitt on ‘vanishing’ C+B services

A GP has questioned health secretary Patricia Hewitt about the use of Choose and Book for demand management as a forthcoming survey highlights growing disquiet among doctors about “vanishing services” on the e-booking system.

Dr Andrew Gray, a GP at the Village Medical Centre in Great Denham, Bedford, used last week’s webchat with Patricia Hewitt as an opportunity to put the health secretary on the spot about Choose and Book.

He told Patricia Hewitt: “Choose and Book has become a way for hospitals to manage their waiting lists, not a way for increasing choice. Hospitals are taking whole departments off-line when they are approaching a 14 week wait time. Two Fridays ago, there were no orthopaedic appointments from Bedford anywhere. Is this what you intended? If not, what are you proposing to do about this?”

In response the health secretary said: “Thanks for drawing this to my attention. I’m not sure what is behind the problem you mention in Bedford so I’ll check back on it.”

She did not further tackle the issue of demand management and Choose and Book but went on to say that more and more patients were reporting that they had been offered a choice. She added: “The growing numbers of GP practices where the computerised Choose and Book system is available are generally telling us that it’s working well – and patients love it – but even where it isn’t yet up and running, patients can book directly.”

However a British Medical Association (BMA) survey of doctors’ experiences of Choose and Book, due to be published at the end of this week or early next week, is also expected to highlight doctors’ concerns about demand management and Choose and Book.

James Johnson, BMA council chairman and chair of the BMA IT committee, told a conference at the beginning of this month that the survey showed Choose and Book was “overwhelmingly unpopular” amongst GPs and consultants.

He said particular concerns included frustration at “vanishing services” and queried whether this was the result of trust politically motivated intervention.

According to BMA News Mr Johnson said that Choose and Book was “very open to political manipulation.”

He added: “All the PCT has to do is take out [a choice of hospital] for eight weeks to save money and the patient gets a bad deal.”

GPs are concerned that hospitals are using Choose and Book to manage demand, both by taking clinics off the e-booking service when capacity has been reached and by insisting that all referrals are made via Choose and Book, so that no other appointments can be made.

Last week EHI Primary Care revealed that Milton Keynes PCT had told GPs that referrals not sent via Choose and Book would be rejected (link: http://www.ehiprimarycare.com/news/item.cfm?ID=2456 ) and that Bedfordshire GPs were reporting that Bedford General Hospital was also rejecting referrals not sent via Choose and Book (link: http://www.ehiprimarycare.com/news/item.cfm?ID=2464 ).

Dr Gray’s practice is Bedford routinely refers to Bedford General Hospital but has been told by the trust that all ENT referrals must be made via Choose and Book, even though the practice does not use the e-booking system.

Practice manager Deb Williams said that the practice was a very IT-oriented but had refused to use the system because it took 29 seconds to access a patient record when using Choose and Book.

She told EHI Primary Care: “Connecting for Health has been here to look at it but we are still waiting for a resolution. Why should we accept 29 seconds when a practice not too far away with the same clinical system is accessing patient records in two seconds?”

She added: “We only have one or two ENT referrals a month but I have a referral here that I have had since the 29 January and since then there has been no one at the trust who could take my booking.”

Williams said local practices suspected that the trust was insisting referrals go through Choose and Book to enable it to manage demand and switch off clinics when capacity was reached.

Dr Gray told EHI Primary Care that his patients wanted to go to their local hospital. He added: “I cannot remember the last time a patient wanted to be referred to anywhere other than Bedford, apart from private referrals. They would like to option of going to UCL or Moorfields sometimes but not Luton and Dunstable, Kettering, Watford, the Lister or any of the other available choices.”

Related articles

Milton Keynes mandates Choose and Book use

http://www.ehiprimarycare.com/news/item.cfm?ID=2456

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

http://www.ehiprimarycare.com/news/item.cfm?ID=2464