Milton Keynes PCT mandates Choose and Book use

A primary care trust has told its GPs that referral letters sent direct to a local hospital will be returned to be re-sent using Choose and Book.

Milton Keynes PCT has said that, with the exception of referrals which cannot currently be made using Choose and Book, all referrals must be done through the e-booking system.

In an e-mail to practices last month the PCT stated: “Arrangements are being put in place for referral letters sent (or faxed) directly to Milton Keynes General Hospital to be returned to the referring GP to use CaB.”

The trust said most referrals for a first outpatient appointment can now be made using Choose and Book and that management of referrals via a referral centre will also cease.

EHI Primary Care understands that local GPs have queried the legality of the instruction to route all letters through Choose and Book but been told the PCT is following DH guidance.

Dr Richard Vautrey, a GP in Leeds and one of the negotiators for the BMA’s General Practitioner Committee, said there was no legal basis for such a move.

He told EHI Primary Care: “This is unacceptable and it is our feeling that these sorts of diktats are counterproductive when we are trying to develop and improve a system. People will naturally use a system that is useable and makes life easier but this sort of thing only makes people more antagonistic about the wider agenda and is not the way to encourage them.”

Dr Vautrey said the directed enhanced service (DES) for Choose and Book which offers GPs incentive payments for using the e-booking system was by its nature a voluntary agreement.

“It is not compulsory to take up the DES or use Choose and Book. As the Choose and Book system improves more and more practices will start to use it.”

Dr Vautrey added that, although it had yet to be finalised, it was likely that the DES would run for another year from April.

A spokesperson for the Medical Defence Union said the MDU was unaware of any rules which meant GPs had to use Choose and Book.

She added: “GPs are required to refer in a timely and appropriate manner but there is nothing that sets out the physical methods that must be used for that referral.”

Dr Mark Davies, Connecting for Health’s medical director for Choose and Book, told EHI Primary Care that he would support local health economies moving towards Choose and Book as the usual method of referral although he emphasised that it must be done in consultation with GPs.

He added: “From an efficiency point of view it makes sense to move to a single system but it has to be done in consultation with referrers rather than unilaterally.”

A spokesperson for Milton Keynes PCT told EHI Pimary Care: “This is part of the move towards delivering Choose and Book locally and encouraging GPs to use this referral pathway. The PCT is working closely with GPs in this process.”

Milton Keynes PCT also announced last week that it was putting in place plans to reverse the trend which saw it near the bottom of two recent national surveys on patients choice with fewer than 10% of patients being able to recall being offered a choice of hospital or given the NHS Choosing Your Hospital booklet.

The PCT has invited local organisations, including voluntary and patient groups, the Council and the hospital, to make people more aware of their right to choose where they are treated.

John Lee-Thompson, the PCT’s head of access, booking and choice, said that consultant clinics at Milton Keynes General Hospital are already rapidly filled and highlighted the introduction of the 18 week target for referral to treatment by April 2008.

He added: “Some local doctors argue that patients do not want to be treated elsewhere. But if the results of the survey are accurate, it appears that patients aren’t being provided with information about the alternatives available to them in a manner that might encourage them to think about a hospital other than Milton Keynes General.”