Bob Bury

Choose & Book: Uninformed and unnecessary choice is no choice at all

So, our masters are disappointed that only 40% of patients are being given a choice of provider when they need care. This obsession with choice is really beginning to irritate me.

Patients can only be involved in choosing in those situations where there is more than one equally competent provider of the care they need, and when they have the information they need to make an informed choice between the alternatives. I suspect that this set of circumstances seldom applies.

Instead, we have the ludicrous ‘Choose and Book’ system. This means that, instead of the GP referring you direct to the consultant you actually need to see (having offered you a choice if he or she felt that there was more than one option), the computer spews out a list of hospitals/providers, and the patient takes the forms away, decides which one to choose, and then phones a call centre whose operatives know nothing about their condition, and who may or may not give them an appointment date.

Often, the answer will be that the hospital hasn’t ‘released’ any dates for those clinics yet, and the booking centre tells you to wait to hear from them. Sometimes you do, sometimes you don’t. If the patient hears nothing, it’s then up to them to contact their GP and get them to chase the appointment up – the booking centre won’t do it.

I know all this because I was recently subjected to the C&B nightmare. I won’t bore you with the details, but I’ve had a bit of chest trouble and my GP did some spirometry, telling me that I had a ‘lung age’ (no, me neither) of 90, which was nice. So I needed an appointment with the respiratory physicians. It seemed likely that I had one of the autoimmune fibrotic thingies, so she wanted me to see the chest doc who specialised in that area. But of course, she couldn’t just refer me to him – I had to be offered that revered ‘choice’ – although she did undertake to write him an old-fashioned letter as well, in the hope that I might be diverted to the right clinic.

In the meantime, I had to go away with the forms and start phoning. The computer (not my GP) had generated three choices, which consisted of the three hospitals in Leeds which ran respiratory clinics. I had no way of knowing which of these had the shortest waiting time, or even if the consultant I needed to see had sessions at all of them.

I therefore did what most patients would do, and chose the nearest one, although geographically, there wasn’t much in it.

I rang the booking centre number, giving them my computer-generated username and password, and was duly informed that no clinic slots had yet been released, and that I should wait to hear from them. I was also given a date, two weeks hence, when I should stop waiting, ring my GP and ask them to chase the hospital up. Predictably, that date came and went, and after three weeks, I rang the GP. After getting the engaged tone on four occasions during the morning, I eventually got through, but the secretary that did the chasing wasn’t there. In the event, it didn’t matter, because my appointment arrived later that day.

So what exactly have I gained from this process of Choice? Absolutely nothing, other than a whole lot of buggeration for me and, potentially, for the overworked staff at my GP surgery, if they had needed to start chivvying the hospital.

In the past, my GP would simply have referred me to the right consultant, and his or her secretary or clinic staff would have sent me an appointment with a degree of urgency appropriate for my clinical condition.

They were able to do that because they were professionals, and not untrained call centre operatives. As far as I can see, the only point of choose and book is to comply with waiting time targets by assigning patients automatically to the next available slot – something which computers and call centres are good at. Unfortunately, what they are not good at is getting the right patient into the right slot.

And look, I’m a computer-savvy ex-medic, with good access to communications and my own transport. If I found the process time-consuming, irritating and potentially confusing, what about the proverbial LOL, hard of hearing and unfamiliar with usernames and passwords and with only limited access to the telephone?

Nine times out of ten, the GP knows exactly who the patient needs to see, and patients who think they know better are usually wrong; not because they are stupid (well, not always), but because they don’t have access to the information needed to make a sensible choice. I shall now confirm my dinosaur status by saying that what patients want is not necessarily what they need. Were that not the case, the focus groups wouldn’t have voted for NHS Direct.

Uninformed and unnecessary choice is no choice at all, just more box-ticking.

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2 Responses to “Choose & Book: Uninformed and unnecessary choice is no choice at all”

  1. bob.bury says:

    Incidentally – have just read my appointment letter properly, and it’s for one of the hospitals I didn’t choose. Hopefully, that’s because the chap I need to see only works there, but it just illustrates the illusory nature of the ‘choice’ I was offered.

  2. mct.morrison says:

    You are oh so right, Bob!

    Nearly all the ‘complaints’ I get – from the Seniors at the golf club! – are about the ‘administration’ and appointments. Nearly all have nothing but praise for the ‘doctors and nurses’.

    A year or two ago I suffered a similar fate. I had seen the consultant and been sent the date for my operation. I then got an appointment for the pre-op assessment clinic – ONE WEEK AFTER THE DATE FOR THE OP.!!! I phoned to point out their mistake and was sent (not given over the phone!) an appt. BEFORE the op. for 10.30 am; I attended at that time to be told they were not expecting me till 11.30 (the time they had)! I showed them the letter and they did ‘fit me in’ before 11.30!

    What worries me is that THE PROFESSION has allowed this to happen! There must be times when such administrative ‘errors’ (the polite word for it!) put patients at risk of serious harm. As clinicians, WE should be dictating how we want our clinics run – sorry, ‘administered’ – and ensuring that it happens.

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