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Choose and Book – some useful hints for practices

(Amended and reprinted with permission from the original joint document published by NHS Bedfordshire and Bedfordshire LMC)

Here are some important principles about Choose and Book. They have been agreed both with NHS Bedfordshire and the LMC.

Privileges for GPs

At all times GPs have an absolute right to make a paper referral. No hospital or other secondary provider is allowed to refuse a referral simply because of the medium by which it is communicated.

Similarly, no PCT, commissioning group or secondary provider can force you to use a triage service, or a referral centre. You have an absolute right under the law to refuse to use any of these organisations, if nothing else because the choice of the patient must come first and anything limiting your ability to refer is limiting the patient's choice.

The clinical safety of the patient comes first and foremost and nothing should get in the way of this.

Responsibilities of GPs

Some practices do not want to take part in C&B and are happy to allow other administrators to act as a referral agency on their behalf. There is no reason why you should not use PCT or PBC referral centres if you want to, but there is a potential legal trap in that if you allow other agencies to organise referrals on your behalf you are legally responsible for any mistakes (including breach of confidentiality) that they may make.

You may have special responsibilities under any local C&B LES you are taking part in, such as using electronic booking whenever possible. A LES is also likely to ask that:

You will give each patient the choice of at least four different secondary providers.

The patient will leave the practice with clear expectations and an understanding of the next steps to be followed to secure their appointment.

If the patient is to be sent further information about making their booking they will receive it within three working days from the generation of the UBRN.

A referral letter to the secondary provider will need to be attached to the electronic C&B referral within three days, unless there is a genuine reason for delay — such as waiting for the results of laboratory investigations.

In any case, these are good principles to employ.

Responsibilities of hospitals

From time to time we hear about hospitals gaming targets. There are all sorts of ways in which this can happen and all of them are outside the regulations. Well-known ploys include:-

Insisting that all referrals are performed electronically (completely outside the regulations).

Asking for a prior fax before accepting the referral (which allows hospitals to cherry-pick cases).

Taking clinics out of C&B to avoid breaching the 18-week targets. (This is absolutely forbidden and the National C&B organisers wish to hear of any incidents of this nature.)

Requiring GPs to refer to a triage centre rather than to a consultant. As a GP you have an absolute right to refer to a consultant.

Accepting an electronic booking, then telling patients that there are no slots available when they ring to make the appointment. Some even ask the patients to go back to their GP to be re-referred. (The hospitals have a duty to provide enough slots to satisfy the electronic bookings they have taken.)

Support for hospital colleagues

Currently there are a number of issues around referrals to named consultants (assuming you are allowed to refer to named consultants in your area) especially where a particular consultant is very popular and their waiting lists risk breaching the 18-week limit. Please be aware that the hospitals often want to shift referrals away from one consultant in order to avoid breaching these rules: therefore, if you have no particular reason to refer to a particular consultant you may want to refer just to the unit itself. Adopting this strategy will allow you and your fellow GPs an increased ability to use referrals to named consultants on other occasions, when they really are desired.

Helping patients

• What can you do if English is a second language for your patient? There are a number of Acrobat files available describing in other languages how C&B works. The leaflet ‘ An introduction to Choose and Book for patients’ is available in the following sixteen languages, as well as in large print, audio and braille. You can order these materials, free of charge, either by calling 08453 700760 and quoting the product name and reference number, or alternatively online by clicking here .
• Albanian (v1, 1495 Kb, application/pdf)  (Order REF:2241/Albanian)

• Arabic (v1, 4007 Kb, application/pdf) (Order REF: 2241/Arabic)
• Bengali (v1, 5352 Kb, application/pdf) (Order REF: 2241/Bengali)
• Chinese (Cantonese) (v1, 1794 Kb, application/pdf) (Order REF: 2241/Chinese (Cantonese))
• Croatian (v1, 1496 Kb, application/pdf) (Order REF: 2241/Croatian)
• Farsi (v1, 3777 Kb, application/pdf) (Order REF: 2241/Farsi)
• French (v1, 1517 Kb, application/pdf) (Order REF: 2241/French)
• Greek (v1, 1542 Kb, application/pdf) (Order REF: 2241/Greek)
• Gujarati (v1, 4631 Kb, application/pdf) (Order REF: 2241/Gujarati)
• Polish (v1, 1503 Kb, application/pdf) (Order REF: 2241/Polish)
• Punjabi (v1, 4805 Kb, application/pdf) (Order REF: 2241/Punjabi)
• Somali (v1, 1501 Kb, application/pdf) (Order REF: 2241/Somali)
• Tamil (v1, 4685 Kb, application/pdf) (Order REF: 2241/Tamil)
• Turkish (v1, 1498 Kb, application/pdf) (Order REF: 2241/Turkish)
• Urdu (v1, 4026 Kb, application/pdf) (Order REF: 2241/Urdu)
• Vietnamese (v1, 1556 Kb, application/pdf) (Order REF: 2241/Vietnamese)
• Large print version (v1, 406 Kb, application/pdf) (Order REF: 3252)
• Audio version  (v1, 86 Kb, application/pdf) (Order REF: 3254)
• Braille version (Order REF: 3253)

• Many patients find that telephoning to make bookings means they are hanging on for up to thirty minutes — expensive for everyone, but especially for those on low incomes. Where direct booking is available, using the web to make bookings will probably be quicker, but this will remain a problem until all secondary providers are on-line for this service.
  The patient will only save money through contacting the national helpline (an 0845 number) if the hospital into which the patient is booking offers a Directly Bookable service. If the hospital does not offer Direct Booking the patient will be asked to call the local hospital direct (thus making two calls instead of one). In addition, the local hospital will have a local number which allows the patient to use free minutes on their mobiles (not usually available when calling 0845 numbers).

Information: new national C&B website design – have a look.

Training information is available on the following website:

www.chooseandbook.nhs.uk/staff/live/training