Burke and Hare do Choose and Book 001.

As the festive season approaches you may be struggling to find a present for someone. If you are looking for something that will cost you your marriage or lose you a life long friend and that special someone happens to be a user of the Choose and Book (C&B) system may we suggest you look no further than here.

This little festive gem will bring seasonal joy to any user, or non-user, of C&B as we hope we shall show with some extracts from its 24 pages of joyous reading. It was found using a link from the weekly BMA unsolicited email shot to its member using the intriguing title of “How to use Choose and Book correctly” or to give its official title “Responsibilities and operational requirements for the correct use of Choose and Book”.

Now it is cold and damp outside in Northernshire today so, dear reader, pull your chair closer to the fire, pour yourself a glass of mulled wine and something for your blood pressure and we shall examine some of the pearls of festive joy we have discovered.

Look first at who the “Target Audience” is, well it is the Christmas panto season, on the second page (PCT CEs, NHS Trusts CEs, SHAs CEs, Communications Leads, SHA Directors of Performance, SHA Chief Information Officers, SHA Choose and Book Leads) and then look at the extensive circulation list. Clearly this document is intended for those who use C&B are a daily basis.

Read the Foreward obviously written by retired doctors who have not worked with patients for years as the following sentence clearly illustrates:

“As set out in the Operating Framework for 2009/10, the long term transformation of the NHS requires a move away from top-down methods to an enabling role for the centre, with more power and responsibility residing with patients and clinicians.”

The next and finally paragraph illustrates so well this monumental sea change in Party Central policy change comrades as more than mere words:

“This guidance has therefore been prepared to help organisations understand the importance of using Choose and Book correctly. Standards and requirements described here should be recognised and implemented in all organisations using Choose and Book and providing services to NHS patients so that all patients wherever they are in England experience the same high quality access to NHS care.”

Fired up with winter warmth from these inspiring seasonal words lets us continue onto the first Chapter “Clinicians using the system themselves”.

“Whilst aiming to be flexible and support many different models of referral, Choose and Book was designed, and is still intended, to be used by clinical staff to initiate and accept a referral, with non-clinicians fulfilling some of the purely administrative functions associated with the process.

The ‘Gold Standard’ for the correct use of Choose and Book is, therefore, for a referrer to have a choice discussion with the patient and subsequently to initiate the referral, with the patient still in the consultation.”

The last paragraph reads:

“Within a provider organisation, the ‘Gold Standard’ is for a clinician to review their own referrals online, accepting, re-directing and rejecting referrals themselves using Choose and Book, and for provider administration staff to do any re-booking, letter-issuing or other administrative tasks, as required.”

We wonder how many real working GPs in the UK will recognize this as the antithesis of how C&B is being used? No Brownie points for any of us here at ND Central or we suspect in most UK practices. Another glass of mulled wine to ease the next chapter in?

Chapter 2 “Free Choice”.

Well that glass went down very quickly and rapidly into the fire but please do not do this, dear reader, as glass in the ashes is a Health and Safety issue for our maids.

Chapter 3 “Promoting (not mandating) the use of Choose and Book”.

1st paragraph reads:

“PCTs should encourage referrers and provider organisations to use Choose and Book wherever possible, by actively demonstrating its benefits rather than by mandating its use.”

Clearly no local Politburo commissars know this as C&B has been MANDATORY for all referrals (apart from the several pages of exclusions of course) forever as local PCT commissars crawl up politicians’ gastrointestinal tract in search of the Order of Gordon 1st Class for being good little comrade Soviet top down enforcers.

“Choose and Book is by far the safest and most reliable way to make patient referrals. In a choice environment, where patients have the option of going to a wide range of provider organisations, it is simply not practical to rely on the old, paper-referral method. PCTs should therefore work with local referrers to help them understand all the benefits of Choose and Book (for both themselves and their patients), helping them to overcome real or perceived barriers that are in the way of effective implementation and proactively encourage usage of the system.”

We like that paragraph lots of weaselly management speak like “it is simply not practical to rely on the old, paper-referral method.” Why it was less work, less paper, quicker, cheaper easier to use for all involved and meant the patient saw the right doctor?

“helping them to overcome real or perceived barriers” The real barriers are the biggest obstacle for any real doctor or secretary using it as crap is crap and the stench of uselessness is real to all who struggle to use it. But then:

“Use of Choose and Book should not, however, be made mandatory.”

Praise be to the Party for this little gem which we shall return to. Please feel free to read it for yourselves and compare it to your own experience of C&B.

We would however recommend a good case of wine and a catering pack of your favoured antihypertensive agent be on hand as you do so.