Chris Lancelot on ... Choose and Book referrals

I've just been reduced to teeth-grinding fury by Choose and Book (C&B). This time the problem isn't the software but the inane implementation of referrals. All power corrupts, and absolute power corrupts absolutely: the new referrals' process shows what happens when managerial control, unrestrained by medical good sense, is let loose on the NHS.

Our local hospital has decided unilaterally that it will no longer accept paper referrals - but the exceptions to this rule change by the week, so no one knows for certain what to do.

My secretaries and the hospital secretaries are now on first-name terms because they have to contact each other so often. Against our specific, expressed wishes, GPs aren't allowed to refer to named consultants any longer.

Throughout the country referrals are being rejected for the craziest of reasons, ruining GPs' C&B statistics in the process. I have even heard of one provider unit which accepts the electronic C&B referral, then tells the patient when they ring up that their books are full, and they must ask their GP for a re-referral elsewhere.

Many hospitals are using C&B to limit outpatient access in order to hit waiting list targets - particularly difficult in the shires where local residents are faced with an overland trek to find any alternative hospital.

Because they are not allowed to make internal referrals, consultants return patients to GPs simply for re-referral to the same hospital.

This is madness. We need to regain some important referral principles: GPs should have a right to refer only by paper if they choose; a right to refer to a named consultant; and all patients should have the absolute right to be referred to their local district general hospital.

Where is the BMA when we need it? It seems to have gone AWOL. At a time when we need national action to curb this stupidity the BMA is wasting its time pontificating on ethics, or organising public demonstrations in support of the NHS. Where it could be of practical use, it is inactive.

These new referral processes inconvenience patients, increase GPs' workload and benefit no one apart from hospital and PCT managers. We need national action to boycott the new system until sanity returns and a decent, professionally led, responsive referral process is put in its place. BMA - wake up, will you?

Dr Lancelot is a GP from Lancashire. Email him at

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