Black attacks Choose and Book

Tags: Choice Choose and Book efficiency GP GPs

23 Jan 2009

Choose and Book has reduced healthcare to a factory production line that is detrimental to patient care, the president of the Royal College of Surgeons has claimed.

John Black said the traditional system meant patients were referred from their GP to a single consultant, who would then oversee the whole process of care from initial consultation to final discharge.

Writing a viewpoint for the BBC website, he argued that direct professional relationships between GPs and local hospital doctors were vital and that they enabled GPs to select the right consultant for each patient, based not just on the type of operation required and technical competencies of the surgeon, but also on personality.

He said: “This cord between GPs and surgeons has been cut by the computerised Choose and Book system, which purports to offer greater patient choice but which has had the opposite effect.”

However the Department of Health claimed that while GPs' knowledge of local service would always be invaluable, the public expected and welcomed choice.

In a statement, it added: "Rather than forcing patients and their doctors apart, Choice allows patients to be active participants in their healthcare alongside the guidance of their GP. Choice has also helped drive up standards across the NHS in England."

The ability of GPs to refer to named consultants using the Choose and Book system has been the subject of some dispute in the NHS. The Choose and Book national team is encouraging hospitals to include named consultant referrals wherever possible on the Directory of Services, but some hospitals have so far opted not to do so, leaving some GPs to use a paper referral to an individual doctor.

Black argued that patients may not know enough to make an informed choice and instead welcomed advice and input from their GP and the opportunity to be seen by just one consultant.

He added: “You might be seen initially by Consultant A, come back for your results to see Consultant B, go on to a common waiting list and then have your actual operation done by Consultant C, whom you might meet for the first time on the morning of your operation.

You may well be sent home the following day by Consultant D and if you are fortunate enough to have a follow up consultation, you may be seen by consultant E.

Mr Black called for it to “again be the norm” for patients to be referred to an individual consultant who would be responsible for their care throughout the clinical episode.

He added: “Using the latest technology to increase the efficiency of the health service and measure how patients' lives are improved is vital.

But this must be sensitive to the individual patient and must retain personal professional judgement. The current system in the NHS is forcing patients and doctors apart and I believe the delivery of care is poorer without those personal relationships.”

Fiona Barr

Reader's Comments

Well said

23 Jan 09 14:01

IMHO the only function of the Choose and Book system is to break the lines of communication between GP and Consultant - they no longer have any clinical relationship. It is highly damaging.

You only have to look at the sort of games that C&B results in to see why so many GPs, Consultants - and patients - dislike it:

http://tinyurl.com/dl6n7z

Drivel

26 Jan 09 12:01

I'm disappointed that John Black has not chosen to check his facts before posting this rubbish on the BBC website.

Choose and Book FULLY supports referral into named clinicians if supported by the hospital. The article suggests that where hospitals choose not to offer this in their directory of service you can get it by referring by paper - drivel!

If the hospital chooses not to offer referral to named clinician it doesn't matter if you refer through Choose and Book, by paper or by carrier pigeon, you will still be seen in a pooled clinic. The only difference being that Choose and Book does not make any claims to offer a service that the hospital does not provide.

He then goes on to discuss being seen by one consultant and then having follow up appointrments with another, failing to realise that Choose and Book supports only first outpatient appointments anyway.

Criticise by all means but please get your facts right first.

So good?

26 Jan 09 16:01

If C&B is so good, why is it only being used for first out-patient appointments?

If C&B is so good, why has use of it stagnated at 50%?

If C&B is so good, why do you have to pay GPs to use it? People pay to use good software, not the other way round.

Re. Drivel

26 Jan 09 18:01

Well said - I posted to the same effect but it didn't appear here.

CaB is once again being blamed for the (mis)behaviour of Acute providers who disable functionality that was designed in at the request of GPs and Consultants.

As for "So good?"- 1:-CaB was designed for 1st Outpatient referrals only. It does what it was asked to do.

2:-One of the reasons it's stagnated at 50% is Acute providers failing to manage their end (slot unavailability, no named clinician referral etc.) while another is articles like John Black's which condemn on false premises.

3:- When many of my colleagues use CaB for 80-95% of their referrals and enthuse about their patients' experience, I too wonder how the incentive schemes are justified.

Drivel

26 Jan 09 19:01

I am disappointed that Mr Black is being criticised by someone who hasn't understood the point he is making. It is precisely because C&B doesn't get the patient to see the consultant of choice at first booking that the subsequent appointments are with a different consultant to the one first receiving the referral.

By all means defend choose and book if that is what you're being paid to do, but at least first try to understand the criticisms that so many of us are prepared to make for free.

Drivel

27 Jan 09 20:01

Drivel says: - - - - - - He then goes on to discuss being seen by one consultant and then having follow up appointrments with another, failing to realise that Choose and Book supports only first outpatient appointments anyway.

Criticise by all means but please get your facts right first. - - - - - -

Drivel fails to recognise a self-fulfillingly prophecy when it punches him on the nose! If C&B only supports first referrals _and_ doesn't support named referrals (which it, almost universally, doesn't) then the majority of re-referrals will end up in the wrong consultant clinic. Hence a lot of follow-up appointments with another consultant (the one who should have seen the patient in the first place).

Incidentally: why does C&B only support first referral? In my experience re-referral is far from an uncommon requirement - but then I am just a GP, after all!

This is clearly a C&B rather than a referrer problem.

Referal to named consultant

28 Jan 09 10:01

The answer to this is quite simple. Gather the evidence rather than relying on prejudice and anecdote. Two clear questions are being asked

Question 1 Does enabling the the GP to refer to a named Consultant cause fewer or more transfers between consultants after the initial patient visit.

Question 2 Does enabling the the GP to refer to a named Consultant speed or slow the process of treament.

There is a third and most important question

Question 3

Does enabling the the GP to refer to a named Consultant improve patient eperience and patient outcomes

Compare with GP2GP

28 Jan 09 11:01

Can I suggest that those who attempt to excuse the manifest and manifold failures of Choose & Book by blaming them all on change-averse GPs and consultants take a look at EHIs latest article on the rampant success of GP2GP.

Funny how quickly GPs take up useful stuff which is good for patients, convenient for practices and actually does what it says on the tin. And OHMIGOD!! nobody's even having to pay them to do it!

re: Compare with GP2GP

Neil.Bhatia@nhs.net

28 Jan 09 15:01

I couldn't agree more.

GP2GP works very well, even better if EMIS-EMIS, and is a real success. No inducement, no "enhanced service", no threats, no complaints.

We gave up on C&B back in April 2007 and I (as lead) haven't looked back since. The GP and secretary time freed up was huge. If you have good referral procedures and protocols within a surgery then referrals by paper work great and are far less time consuming that the shambolic C&B application. I type my own referrals and, to certain local providers, email them (nhs.net - nhs.net).

Who's to blame?

13 Feb 09 12:02

I have worked in healthcare for about 26 years, I have been working with Choose and Book for about 4 years (no I don't work for CfH or NPfIT). The one common theme I have found is that regardless of which area of the health community the C & B nay sayers come from they almost always (without exception) are commenting without full understanding or facts.

Even more frustrating is that the CfH/NPfIT response always comes over as repetitive, scripted (counter productive) propaganda.

There in lies the problem, no new system is perfect but only ever improves with collaboration, "honest and factual" communication, engagement, true awareness and understanding. And remembering that the biological component of the any new IT system is the key to its success.

It is also all to easy when not fully informed or willing to understand/listen, to stamp down new ideas without realising their potential.

No one likes change, to improve things there must be change (evolution), but if the change is not managed correctly then it will never happen.

So who's to blame, if its not the C & B system, not the GP's, not the Consultants, then who....it is working in some regions and not in others, so maybe the spotlight should be on those responsible for managing the change.

"How can this help us and how can we get the best out of this" is a far better approach than "Thou shalt" as the only response is "I shan't"