Tuesday, 22 September 2009

Choose and Book. What a massive waste of money.

Title says it all really. I'll explain why in a mo,

First apologies for not updating this blog sooner. 3 reasons
1) Been on holiday - very nice it was too
2) Couldn't decide on a topic
3) I'm lazy (main reason)

So much has happened since I last blogged. From Tamiflu being declared rubbish (we knew that already), CRB checks for all (we're all paedophiles til proven otherwise apparently), and the government keen to get rid of GP boundaries (did they actually talk to any GPs about this idea or did they, as a colleague suggested, simply run it past a Question Time audience to see if they clapped?). Thats just a start, there are other things but, er, I've forgotten.

Anyway, to the subject at hand, Choose and Book (CAB). Have you seen your GP and been referred to secondary care (hospital etc..)? What should happen is the GP asks you where you would like to go and then books the appointment for you. A short wait and then you are seen in the hospital of your choice. Sounds like a neat idea, you could pick a hospital near work for example rather than the run down portacabin round the corner. The idea ( I think) was to create a sort of marketplace where hospitals compete for your 'custom' which in turn drives up standards and improves care.

A nice idea you might think but the NHS being what it is its a complete and utter shambles. What used to happen before all this was you'd see the GP, (s)he would recommend referral, sort out a letter, it'd get sent and a few weeks (or more) later you'd get an appointment. The GP could even refer you to a specific consultant so you wouldn't have to see the dodgy crap one that every knows is shit but too scared to say anything about.

Simple. Doc ->letter->Consultant. Job done.

Now what happens is you see the GP and they recommend referral. Where I work the doc does the next step but I know in other areas its handled by a dedicated team. The doc explains to you that you now have a choice of where you go. In fact they mention the word choice several times. This is because the powers-that-be occasionally monitor patients to see if GPs have offered them choice. Next step is logging onto the Choose and Book website. (How much did that cost??). Whats been happening recently is that the screen freezes and the entire thing crashes so the GP mutters under their breath and sends a referral the old fashioned way (sort of).

Assuming the website works the GP types in what service they want to refer you to and then the computer returns a list of available hospitals and such like that offer this service. This list used to be 5-6 local services, its been changed now so it shows every place in the UK that offers the service. Quite why anyone would want to go somewhere that is hundreds of miles away is beyond me but you have that choice so the Government is happy. Rather cheekily it also lists at least 1 private provider. It also lists waiting times - where I work this is woefully inaccurate and out by weeks.

You ask to see a specific consultant but the GP tells you that you don't have that choice. (Infact if truth be known you'll probably end up with the dodgy shit consultant as they have the shortest list.) You pick a place, GP confirms, prints out a form with a password, reference number and telephone number (assuming the printer works). You then phone this number a few days later (to let the referral letter reach them first, otherwise they can't do anything) and confirm who you are with the password etc and you are given a date for your clinic. You have to phone them fairly soon, if you leave it more than a week or two the referral is returned back to the GP. Finally you get to see the consultant, only its not a consultant, its a nurse practitioner.

So the new pathway is GP->Choose and book website->patient phones booking system->booking system liase with hospital->appointment booked->seen in clinic (might not be the one the GP wanted though)

Ok problems.
1) Patients actually want to go to their local hospital and see a named consultant ->can't do that
2) Special referral pathways have been set up to triage referrals and make sure they go to the right place ->CAB overrides this so trivial stuff now takes up consultant clinics rather than more complex cases
3) GPs don't know much about all the different services on offer so can't offer advice as to whats best
4) Patients sometimes make wrong decisions about where they want to go
5)It assumes patients have a good reading level (not all do). Bit stuck if they can't read the info.
6)Some services are overrun and waiting list times have soared, other services are underbooked. No way of moving patients to these underbooked clinics which would save time
7)Try explaining CAB to elderly patients and they haven't a clue what you are talking about. Large numbers fail to attend hospital or referrals are bounced as they didn't phone to confirm
8)Try explaining CAB to patients where English isn't their first language and they haven't a clue what you are talking about. Large numbers fail to attend hospital or referrals are bounced as they didn't phone to confirm
9)Website crashes.
10)Hospital clinics are being filled inappropriately due to an inept booking centre
11)Services have got worse not better.
12)The amount of effort its taken to set up a service that, in my opinion, is actually worse than the old system is quite breath taking.

Neat huh? I have yet to meet a GP who thinks that CAB was a good idea that works well. Its a bad idea, that works badly. Genius.


  1. Interesting. Just started to follow you on Twitter. I have often wondered about the Choose and Book system - it seemed much easier before - see GP (not on Monday at my surgery... be wise to leave it a couple of days, let all the lazy arses get their "illnesses" off their chests!) explain symptoms, Dr dictates letter, you get an appointment, attend said appointment. No need to change it was there? My mother is almost 82 and had bowel cancer last year - on the run up to the diagnosis she had umpteen letters suggesting she went online to make the appointments.... they may as well have told her to fly to the moon.

    I shall follow your blogs with interest!

  2. It works a bit different at my GP. GP or team send letter with appointment at nearest hospital, accompanying it is this Thank you for choosing CAB letter. with all the gumph. Gumph is thrown away. Get auto phone call a few days before app asking for x then x's DOB to confirm who it is. then asks to press 1 to confirm you'll be attending. I can understand the confirming bit for a reminder, as people don't attend causing a waste of time. but for the rest .. more pen pushers taking the jobs away from the medical side? The world is upside down!

  3. I try, I really do, to big up the NHS and have faith in it....and then I read this from someone who actually knows and it's pretty scary!

    I currently care for my father who has metastatic pancreatic ca. and whilst the quality of care 'one on one' from nursing and medical professionals is fantastic I feel as though I need at least a degree in pharmacology and more so another in admin. to cope.....so I have to say, your post doesn't surprise me, half of my life is currently spent fighting diabolical NHS admin. systems!

  4. The one time I've used CAB my doctor made the initial appointment for me, somewhere closeish but not too far in the future, and then they confirmed with me later.

    I somehow got scheduled for an unneccesary second examination and not the minor procedure I needed. The hospital spotted that and cancelled my appointment and then I had to wait for a new one, but it was too late to choose somewhere else.

    It's a nice idea but it could use some work.

    (Why dont my arrow keys work in this text editor?)