Chris Lancelot: Lansley must heed warnings of Choose and Book

When health secretary Andrew Lansley starts streamlining the NHS he would do well to begin with Choose and Book. In its current form it's an object lesson in how to get things completely wrong.

The GP Record, by Fran Orford

Choose and Book was designed without any GP input, and it shows. Everything that GPs requested - such as availability of referrals to named consultants, and an efficient system that doesn't intrude on clinical time - were completely ignored.

DoH managers didn't even realise that most hospitals' IT was so out-of-date they couldn't benefit economically from receiving referrals in electronic form. Instead of work flowing electronically, many have to print them off and pass them round in paper form. Choose and Book is supposed to make the referral process more cost effective - but only if the DoH discounts the extra time needed in primary care to run it.

Ideally, Choose and Book should have been introduced in 'big-bang' fashion, with all services fully up to speed on day one. Going off at half-cock was bound to cause confusion. Even now only a percentage of services are electronically available; some are direct booking, some are telephone only, some referrals still have to be made on paper ...

Instructions change from day to day.

GPs do not know what is happening and may have to refer to e-mails and spreadsheets going back several months to discover whether or not a clinic is currently available through Choose and Book. What a waste of clinical time! Don't managers understand that a simple, consistent procedure is usually the best?

Finally, most people use IT developments, such as word processors and spreadsheets, because they save time, or else do the job more efficiently. It has not occurred to DoH managers that the reason why GPs have to be cajoled, bribed, and strong-armed into using Choose and Book is because, as currently configured, it has few benefits.

Choose and Book is a truly great idea which has been ruined because NHS managers didn't seek GP advice, didn't value our time, didn't employ joined-up thinking, and wouldn't listen to criticism. Heads should roll: this is a disgraceful way to waste both NHS money and precious clinical time. Mr Lansley, take note.

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