Chris Lancelot: The only joined up thing about Choose and Book is its name

One of the most disturbing features about the DH's attitude to Choose and Book is its sloppy, disjointed thinking.

Indeed, the only joined-up aspect of Choose and Book is its name. 'Choose and Book' trips off the tongue nicely, don't you think? But the two processes are quite independent. Patients can be given a choice without their GP using the system. (Simply ask them where they want to be referred. We've been doing it for ages.)

Then there's booking - either through the electronic system, or by sending the referral letter to the hospital. 'Choose' then book. 'Book', having first chosen. These are completely independent functions.

Yet the outpourings from the DH assume choosing and booking are inseparably entwined. And Choose and Book use is declining, it says. How dreadful. This clearly means patients aren't being given choice, and choice is what Choose and Book is all about, apparently.

So the DH is increasing the pressure on GPs to use Choose and Book to rectify this 'omission'. Clinical commissioning groups are issuing targets for Choose and Book use: some are even threatening to publish league tables of practices' uptake to name and shame those GPs who won't let patients choose their secondary care provider.

When will the government and the DH get it into their corporate heads that the reason why practices don't use their precious Choose and Book system has nothing to do with choice, which we offer already? Instead, the low uptake is the fault of its technical and organisational aspects, which are truly abysmal.

The software is clumsy, searches take ages, hospitals don't put their clinics on the system in an orderly or consistent fashion, and frequently manipulate outpatient appointments in ways the DH seems powerless to prevent. 'Choice' isn't the problem: it's the entirely independent booking system that needs fixing.

Choose and Book is a classic example of central ineptitude, followed by a determined attempt both to shift the blame on to someone else and provide a fix which doesn't address the real problem. I'm not buying into the DH's twisted logic, nor should anyone else.

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